Does C1764 require prior authorization?

No, C1764 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C1764` — Event recorder, cardiac (implantable)

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For ILR in recurrent or unexplained syncope: documentation that non-arrhythmic causes have been excluded by appropriate testing (e.g., reflex syncope, orthostatic hypotension, volume depletion, dehydration, blood loss).
For ILR in recurrent or unexplained syncope and for cryptogenic stroke/TIA: documentation that noninvasive ambulatory cardiac monitoring for a minimum of 14 days was performed and was inconclusive or non-diagnostic (e.g., patch monitors, external event monitors).
For replacement of an implantable electrocardiographic event monitor: documentation that the individual continues to meet ALL ILR criteria and that the existing monitor is no longer under warranty and cannot be repaired (e.g., device nearing end of battery life).
For pediatric ILR: documentation that an external monitor has not demonstrated the symptoms of concern prior to ILR implantation.

Ambulatory external cardiac monitoring from 48 hours to 30 days (Current Procedural Terminology [CPT®] codes 93241-93248, 93268, 93270-93272, 0937T-0940T) is considered medically necessary when ANY of the following criteria are met:
symptoms of presyncope, syncope, or severe palpitations when there is clinical suspicion of a significant bradyarrhythmia or tachyarrhythmia
evaluation of atrial fibrillation for rhythm and/or rate control when the results will directly impact clinical decision-making (pre- and/or post-ablation)
following stroke or transient ischemic attack (TIA) of undetermined cause (CPT® 93268, 93270-93272)
following cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFL) if individual is not receiving ongoing anticoagulation and deemed to be at high thromboembolic risk (e.g., CHA2DS2-VASc score ≥ 2)
individual with hypertrophic cardiomyopathy

AMBETTER-CP.MP.243 — Implantable Loop Recorder

CIGNA-0547 — Ambulatory External and Implantable Electrocardiographic Monitoring - (0547)

ANTHEM-CG-MED-74 — CG-MED-74 Implantable Ambulatory Event Monitors and Mobile Cardiac Telemetry

CARELON-ambulatory-cardiac-rhythm-monitoring-2024-07-01 — Ambulatory Cardiac Rhythm Monitoring

Ask Verity about documentation requirements, denial risks, or coverage in your state.