Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

Holter monitoring codes (CPT 93224-93227) are covered for up to 48 hours when medical necessity is documented; long-term recorders (CPT 93241-93248) are covered for >48 hours up to 7 or 15 days in outpatient settings. Wearable mobile cardiac telemetry (CPT 93228 professional, 93229 technical) is billed as one unit per episode covering up to 30 consecutive days with specific service elements and DOS/reporting rules; mutually exclusive billing and documentation, IDTF, and modifier restrictions apply. National non-covered items include time-sampling mode event monitoring, home EKG without medical necessity, certain emergency portable-x-ray–supplied EKGs, and separate physician services not meeting IDTF or attending/consulting physician criteria.

"Holter monitoring (CPT 93224-93227) is covered for up to 48 hours of continuous recording when progress notes document medical necessity."