CG-MED-40 External Ambulatory Cardiac Monitors

This policy addresses external ambulatory cardiac monitors, specifically continuous 24–48-hour ambulatory ECG Holter monitors. Coverage is medically necessary for adults when used to evaluate frequent unexplained arrhythmic symptoms (e.g., palpitations, dizziness, syncope), assess hypertrophic or dilated cardiomyopathy, detect ventricular arrhythmias or QT/ST changes for risk assessment, or monitor response to antiarrhythmic therapy. It is not covered for any other indications, including autonomic cardiac neuropathy in diabetes or post–myocardial infarction with left ventricular dysfunction (EF ≤40%), and other uses of external ambulatory event monitors/telemetry outside these criteria are also not medically necessary.

"Continuous 24- to 48-hour ambulatory ECG Holter monitor use is consideredmedically necessaryforadultswith any of the following indications:"

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