0938T — Xtrnl ecg rec>15d<30d rec
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- All documentation must be maintained in the patient's medical record, every page must be legible and include patient identification (complete name, dates of service), and be available to the contractor upon request.
- The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- The medical record must support the selected ICD-10-CM diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed (not merely linkage to a correct diagnosis code).
- Documentation must demonstrate the diagnosis or clinical suspicion that led to cardiac monitoring and must support medical necessity for monitoring beyond 24 hours and for the specific type of monitor used.
Key Coverage Criteria
- Ambulatory ECG monitoring is covered when the medical record documents a diagnosis or clinical suspicion of a cardiac event that justifies cardiac monitoring.
- Ambulatory ECG monitoring is covered when documentation shows specific symptoms (syncope, dizziness, shortness of breath, chest discomfort, palpitations), abnormal test results indicating extended monitoring, or an underlying history of cardiac disease that may correlate with a cardiac diagnosis.
- Post-myocardial infarction monitoring should follow NCD 20.15 (Electrocardiographic Services) as applicable for post-infarct guideline-based monitoring.
- Cardiac monitoring is covered when the medical record documents a diagnosis or clinical suspicion of a cardiac event that led to monitoring (e.g., syncope, dizziness, shortness of breath, chest discomfort, palpitations).
- Greater-than-24-hour monitoring is covered when the medical record documents medical necessity for extended monitoring based on symptoms, abnormal test results, or underlying cardiac disease history that may correlate with a cardiac diagnosis.
- Coverage applies for the specific monitor type and duration that match clinical need and coding guidance (Holter, extended external monitors, event monitors, mobile telemetry, or implanted subcutaneous monitor) per the LCD.
17 Active Policies
A59270 — Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring
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L39492 — Ambulatory Electrocardiograph (AECG) Monitoring
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L33693 — Peripheral Venous Ultrasound
J09
A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)
J12
A59268
Related Codes
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