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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 say that an event monitor, or event recorder, is a patient-activated or event-activated EKG device that 
intermittently records cardiac arrhythmic events as they occur. The EKG is recorded on magnetic tape or other 
digital medium. Cardiac event monitor technology varies among different devices. For patient-activated event 
monitors, the patient initiates recording when symptoms appear or when instructed to do so by a physician 
(e.g., following exercise). For self-sensing, automatically triggered monitors, an EKG is automatically recorded 
when the device detects an arrhythmia, without patient intervention. Some devices permit a patient to transmit 
EKG data transtelephonically (i.e., via telephone) to a receiving center where the data is reviewed. A technician 
may be available at these centers to review transmitted data 24 hours per day. In some instances, when the 
EKG is determined to be outside certain pre-set criteria by a technician or other non-physician, a physician is 
available 24 hours per day to review the transmitted data and to make clinical decisions regarding the patient. 
These services are known as 24-hour attended monitoring. In other instances, transmitted EKG data is 
reviewed at a later time and are, therefore, considered non-attended. 
 
The following indications are covered nationally unless otherwise indicated: 
1. Computer analysis of electrocardiograms (EKGs) when furnished in a setting and under the 
circumstances required for coverage of other EKG services. 
2. EKG services rendered by an independent diagnostic testing facility (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 durable medical equipment (DME) separately.  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 in the Centers for 
Medicare and Medicaid Services, Internet Only Manual, Publication 100-03, Medicare National Coverage 
Determination for Electrocardiographic Services, 20.15. 
 
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.