Transient cerebral ischemic attacks and related syndromesĪutonomic neuropathy in diseases classified elsewhere ICD-10 codes covered if selection criteria are met:Į10.40 - E10.49 E10.610 E11.40 - E11.49 E11.610ĭiabetes mellitus with neurological complications HCPCS codes not covered for indications listed in the CPB:Įmpatica E4 wristband - no specific codes Recording (includes connection, recording, and disconnection) Table: CPT Codes / HCPCS Codes / ICD-10 Codes CodeĬPT codes covered if selection criteria are met:Įxternal electrocardiographic monitoring up to 48 hours by continuous rhythm recording and storage includes recording, scanning analysis with report, physician review and interpretation
Note: Routine performance of Holter monitoring has no proven benefit for individuals who are undergoing sleep studies for suspected obstructive sleep apnea. Note: Digitalization and/or color display of results are considered incidental features of Holter monitoring. Note: For Aetna's policy on home-based real-time cardiac surveillance systems (e.g., CardioNet Mobile Outpatient Cardiac Telemetry Service, Cardiac Telecom Telemetry Home Service), see CPB 0073 - Cardiac Event Monitors.Īetna considers the Empatica E4 Wristband experimental and investigational for ambulatory heart rate variability monitoring because its effectiveness has not been established. The literature indicates that if more frequent monitoring is needed to evaluate arrhythmias, use of cardiac event recorders should be considered. Holter monitoring lasting more than 48 hours is generally considered not medically necessary. Holter monitoring is generally considered medically necessary no more frequently than twice in a six month time period. Asymptomatic congenital complete atrioventricular (AV) block in pediatric patients.Īetna considers Holter monitoring experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established.Evaluation of symptoms related to cardiac arrhythmias (e.g., palpitations, syncope or near syncope, unexplained dizziness) or.Post myocardial infarction with left ventricular dysfunction or.Individuals with pain suggestive of variant (Prinzmetal's) angina or.Assessment of the function of pacemakers or implantable cardioverter defibrillators or.Evaluation of possible or documented long QT syndrome or.Idiopathic hypertrophic or dilated cardiomyopathy or.Autonomic cardiac neuropathy associated with diabetes mellitus or.Assessment of efficacy of surgical interventions for the treatment of arrhythmia or.Assessment of efficacy of medications for arrhythmia treatment or.
This Clinical Policy Bulletin addresses holter monitors.Īetna considers Holter monitoring medically necessary for diagnostic evaluation of adult members with any of the following symptoms or conditions: Number: 0019 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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