Billing and Coding: Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

Coverage is determined by meeting the reasonable and necessary clinical criteria in LCD DL40257. Claims must include a valid ICD-10 diagnosis, the ordering/referring provider name and NPI when required, and complete signed medical records with test results or symptom documentation; ABN and modifier rules (GA, GX, GZ, GY) must be followed and certain modifiers/entries may trigger automatic denial or Part A-specific requirements. Adhere to NCCI/CCI and OPPS edits before billing.

"Service is covered when it meets the reasonable and necessary clinical criteria specified in the Local Coverage Determination (LCD) DL40257 for Temporary Nontherapeutic Ambulatory Cardiac Monitorin..."

Sign up to see full coverage criteria, indications, and limitations.