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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 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. 
 
Cardiac event monitors without transtelephonic capability must be removed from the patient and taken to a 
location for review of the stored EKG data. Some devices also permit a "time sampling" mode of operation. 
The "time sampling" mode is not covered under ambulatory EKG monitoring technology. Some cardiac event 
monitoring devices with trans-telephonic capabilities require the patient to dial the phone number of a central 
EKG data reception center and initiate transmission of EKG data. Other devices use Internet-based in-home 
computers to capture and store EKG data. When such devices detect pre-programmed arrhythmias, data is 
automatically sent via modem and standard telephone lines to a central receiving center, or independent 
diagnostic testing facility (IDTF), where the data is reviewed. Internet-based in-home computer systems may 
also provide the receiving center with a daily computer-generated report that summarizes 24 hours of EKG 
data. 
 
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. 
 
You can find this information in the National Coverage Determination NCD 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.