93012
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Evaluation of rate-responsive or physiological pacing function in children with persistent or recurrent cardiac symptoms.
- The use ofexternalambulatory event monitors is consideredmedically necessarywhenEITHERof the following criteria are met (AorB):
- Continuous 24- to 48-hour ambulatory ECG Holter monitor use is consideredmedically necessaryforadultswith any of the following indications:
- As a diagnostic tool to evaluate frequent, unexplained symptoms suggestive of cardiac arrhythmias such as palpitations, unexplained dizziness or syncope or near syncope;or
- Evaluation of hypertrophic cardiomyopathy or dilated cardiomyopathies;or
- As a diagnostic tool for detecting ventricular arrhythmias, QT interval changes, or ST changes, to evaluate risk;or
1 Active Policy
ANTHEM-CG-MED-40 — CG-MED-40 External Ambulatory Cardiac Monitors
Related Codes
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