Medical Policy

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
Limits
Intentially left empty
Reference
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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.