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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 medically necessary services are those that are reasonable and necessary for the diagnosis or 
treatment of an illness or injury. Medically necessary services include services to improve the functioning of a 
malformed body member. You can find this rule in the Social Security Act, Section 1862(a)(1)(A). 
 
The rules say that certain cardiac event monitors capture electrical activity with a single electrode attached to 
the skin. Other devices may employ multiple electrodes in order to record more complex EKG tracings. 
Additionally, devices may be individually programmed to detect patient-specific factors, electrode malfunction, 
or other factors. Cardiac event monitors can be further categorized as either pre-event or post-event 
recorders, based on their memory capabilities: 
 
        a. 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. 
 
        b. 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. 
 
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. 
 
Additionally, the transmitting devices must meet at least the following criteria: 
 
    a. They must be capable of transmitting EKG Leads, I, II, or III; and 
     b. The tracing must be sufficiently comparable to a conventional EKG. 
 
24-hour attended coverage used as early post-hospital monitoring of patients discharged after MI is only 
covered if provision is made for such 24-hour attended coverage in the manner described below: 
 
24-hour attended coverage means there must be, at a monitoring site or central data center, an EKG technician 
or other non-physician, receiving calls and/or EKG data; tape recording devices do not meet this requirement. 
Further, such technicians should have immediate, 24-hour access to a physician to review transmitted data and 
make clinical decisions regarding the patient. The technician should also be instructed as to when and how to 
contact available facilities to assist the patient in case of emergencies. 
 
You can find this information in the NCD: 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.