An insertable loop recorder will be covered:
Only if a definitive diagnosis for syncope (R55) has not been made
after ALL of the following conditions have been met:
Complete history and physical examination;
Two (2) negative or non-diagnostic 30-day pre-symptom memory loop
patient demand recordings (may be either single or multiple event recordings);
Negative or non-diagnostic tilt table testing.
Any other use of this device is considered not medically necessary
and will not be covered.
The ILR device insertion procedure is considered to be a physician
service. It carries a 90 day global and does not require an assistant surgeon.
Removal of an ILR device on the same day as the insertion of a cardiac pacemaker
in any given patient is considered to be a part of the pacemaker insertion
procedure and will not be covered separately.
Used In This BI:
Implantation of patient-activated cardiac event recorder
33285 Insertion, subcut cardiac rhythm monitor, incl programming
E0616 Implantable cardiac event recorder w/memory, activator, and programmer