Appeal type: unknown
Decision: unknown

 
The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules state that  
Pre-symptom Memory Loop Recorder (MLR): Upon detecting symptoms, the wearer presses a button, which 
activates the recorder to save (i.e., memorize) an interval of pre-symptom EKG data along with data during and 
subsequent to the symptomatic event. Self-sensing recorders (also known as event-activated or automatic 
trigger) do not require patient input to capture these data. Single or multiple events may be recorded. The 
device is worn at all times, usually for up to 30 days. 
Implantable (or Insertable Loop) Recorder (ILR): Another type of pre-symptom MLR, it is implanted 
subcutaneously in a patients upper left chest and may remain implanted for many months. An ILR is used 
when syncope is thought to be cardiac-related but is too infrequent to be detected by either a HolterTM monitor 
or a traditional pre-symptom MLR. 
Post-symptom Recorder: The patient temporarily places this device against the chest when symptoms occur 
and activates it by pressing a button. These recorders represent old technology, as they do not include a 
memory loop. The device transmits EKG data telephonically in real-time and is usually used for up to 30 days. 
The following indications are covered nationally unless otherwise indicated: 
1. Computer analysis of EKGs when furnished in a setting and under the circumstances required for 
coverage of other EKG services. 
2. EKG services rendered by an IDTF, including physician review and interpretation. Separate physician 
services are not covered unless he/she is the patients attending or consulting physician. 
3. Emergency EKGs (i.e., when the patient is or may be experiencing a life-threatening event) performed 
as a laboratory or diagnostic service by a portable x-ray supplier only when a physician is in attendance 
at the time the service is performed or immediately thereafter. 
4. Home EKG services with documentation of medical necessity. 
5. Transtelephonic EKG transmissions (effective March 1, 1980) as a diagnostic service for the indications 
described below, when performed with equipment meeting the standards described below, subject to the 
limitations and conditions specified below. Coverage is further limited to the amounts payable with 
respect to the physicians service in interpreting the results of such transmissions, including charges for 
rental of the equipment. The device used by the beneficiary is part of a total diagnostic system and is 
not considered DME separately. Covered uses are to: a. Detect, characterize, and document symptomatic transient arrhythmias; 
b. Initiate, revise, or discontinue arrhythmic drug therapy; or, 
c. Carry-out early post-hospital monitoring of patients discharged after myocardial infarction (MI); 
(only if 24-hour coverage is provided, see C.5. below). 
Certain uses other than those specified above may be covered if, in the judgment of the local Medicare 
Administrative Contractor (MAC), such use is medically necessary. 
You can find this rule at the Medicare National Coverage Determination (NCD) 20.15: Electrocardiographic 
Services. 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.