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

This policy addresses mobile cardiac telemetry (MCT) and implantable ambulatory event monitors for arrhythmia evaluation. MCT is medically necessary when a patient has symptoms suggestive of arrhythmia occurring less than once every 48 hours or suspected paroxysmal atrial fibrillation after cryptogenic stroke to guide anticoagulation, and only after a nondiagnostic external ambulatory event monitor worn continuously for at least 14 days. MCT that does not meet these criteria and implantable ambulatory event monitors are considered not medically necessary.

"The use of mobile cardiac telemetry is consideredmedically necessaryfor individuals who meet criterion A and criterion B below:"

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