Ambulatory Electrocardiograph (AECG) Monitoring

AECG monitoring with FDA-cleared devices is covered when a standard 12-lead ECG, cardiac history, and exam do not satisfactorily explain symptoms and monitoring is expected to change management. Covered indications include unexplained syncope/dizziness/chest pain/palpitations/shortness of breath, bradycardia, nocturnal arrhythmias, atrial fibrillation rate control, anti-arrhythmic drug management, post-ablation or device reprogramming assessment, evaluation after acute coronary syndrome, silent ischemia assessment, evaluation of ventricular ectopy in specified cardiomyopathies, and detection of occult atrial fibrillation in cryptogenic stroke; 24–48 hour monitoring is preferred for daily symptoms and overall duration should match clinical presentation. Non-FDA-cleared devices (including smartphone/wrist-based devices), AECG for ventricular arrhythmias requiring inpatient care, and monitoring from inadequately staffed 24-hour stations are not covered; documentation must include ECG, history/exam, device clearance, appropriate facility staffing, and justification that monitoring will affect treatment.