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Effective Date: 11/01/2011 Title: Mobile Telemetry
Revision Date: 12/06/2011 Document: BI321:00
CPT Code(s): 93228, 93229
Public Statement

Outpatient cardiac telemetry, also known as mobile cardiac outpatient telemetry, is not a covered service.


Medical Statement

The use of outpatient cardiac telemetry (also known as mobile cardiac outpatient telemetry or MCOT) as a diagnostic alternative in patients who experience infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias (i.e., palpitations, dizziness, presyncope, or syncope) is not considered medically necessary. There is a lack of data indicating this testing is more effective than other cardiac event recorders (e.g. 30 day recording) and the procedure is more costly.  

 

Codes Used In This BI:

93228           Remote 30 day ecg rev/report     

93229           Remote 30 day ecg tech supp


Background

Ambulatory event monitors store the recorded data, which are ultimately transmitted either to a physician’s office or to a central recording station. In contrast, outpatient cardiac telemetry provides real-time monitoring and analysis. For example, CardioNet Inc. is a company that offers mobile cardiac outpatient telemetry. In this system, the patient wears a 3-lead sensor, which constantly communicates with the CardioNet monitor, a lightweight unit that can be carried in a pocket or a purse. When an arrhythmia is detected according to preset parameters, the EKG is automatically transmitted to a central CardioNet service center, where the EKG is immediately interpreted, with results sent to the referring physician. The referring physician can request the level and timing of response, ranging from daily reports to stat results.


Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
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