Aetna Cardiac Event Monitors coverage criteria

What this means for the claim

The covered path, the next step to get it approved, and the specific way it denies — built only from this policy.

Coverage criteria

• External intermittent cardiac event monitors (external loop recorders) are covered for ANY ONE of the following: (a) to document a suspected arrhythmia in persons with a non-diagnostic Holter monitor or 48-hour telemetry (e.g., suspected atrial fibrillation as cause of cryptogenic stroke), OR in persons whose symptoms occur infrequently (less frequently than daily); (b) to document ST segment depression for suspected ischemia; (c) to document the benefit after initiating drug therapy for an arrhythmia; (d) to document the recurrence of an arrhythmia after discontinuation of drug therapy; (e) to document the results after an ablation procedure for arrhythmia; (f) to evaluate syncope and lightheadedness in persons with a non-diagnostic Holter monitor or 48-hour telemetry, OR in persons whose symptoms occur infrequently (less frequently than daily).
• Mobile cardiovascular telemetry (MCT) is covered when EITHER of the following is met: (1) Evaluation of recurrent unexplained episodes of presyncope, syncope, palpitations or dizziness when BOTH of the following are met: (a) a cardiac arrhythmia is suspected as the cause of the symptoms, AND (b) the member has a non-diagnostic Holter monitor or 48-hour telemetry, OR symptoms occur infrequently (less frequently than daily); OR (2) Evaluation of members with suspected atrial fibrillation as a cause of cryptogenic stroke who have had a non-diagnostic Holter monitor or 48-hour telemetry.
• Implantable loop recorder (ILR) is covered for evaluation of recurrent unexplained episodes of pre-syncope, syncope, 'seizures', palpitations, or dizziness when BOTH of the following are met: (a) a cardiac arrhythmia is suspected as the cause of the symptoms, AND (b) the member has a non-diagnostic external monitor, OR symptoms occur infrequently such that the arrhythmia is unlikely to be diagnosed by external monitoring.
• Implantable loop recorder (ILR) is covered for evaluation of members with suspected atrial fibrillation as a cause of cryptogenic stroke who have had a non-diagnostic 30-day external mobile cardiovascular telemetry with electrocardiographic recording (mobile cardiac telemetry, MCT).
• Implantable loop recorder (ILR) is covered for surveillance for atrial fibrillation in EITHER of the following circumstances: (a) after ablation of typical atrial flutter (cavotricuspid isthmus), in members with a HATCH score of at least 2; OR (b) after a single occurrence of atrial fibrillation during hospitalization for an acute illness or surgery, in a member with a HATCH score of at least 2.
• Removal of an implantable loop recorder (ILR) when it has reached end-of-life is considered medically necessary and can be approved; however, reimplantation of another ILR must meet a new indication of the aforementioned medically necessary indications to be approved.
• Long-term (greater than 48 hours) external ECG monitoring with continuous rhythm recording and storage (e.g., Zio Patch) is covered to evaluate syncope and lightheadedness in persons with a non-diagnostic Holter monitor or 48-hour telemetry, OR in persons whose symptoms occur infrequently (less frequently than daily) such that the arrhythmia is unlikely to be diagnosed by Holter monitoring.
• Long-term (greater than 48 hours) external ECG monitoring with continuous rhythm recording and storage (e.g., Zio Patch) is covered to document an arrhythmia in persons with a non-diagnostic Holter monitor or 48-hour telemetry, OR in persons whose symptoms occur infrequently (less frequently than daily) such that the arrhythmia is unlikely to be diagnosed by Holter monitoring.

Covered codes

Codes listed in this Aetna policy. Check each one's prior-authorization verdict and Medicare rate:

• 33285·PA verdict·Rate

Documentation required

• Documentation of a prior non-diagnostic Holter monitor or 48-hour telemetry (or 30-day external MCT for ILR in cryptogenic stroke) is referenced as a prerequisite for multiple covered indications
• For ILR atrial fibrillation surveillance after ablation of typical atrial flutter or after a single AF occurrence during hospitalization, documentation of a HATCH score of at least 2 is required

Frequently asked questions

When does Aetna cover Cardiac Event Monitors (CPT 33285), and what gets it denied?

Aetna CPB 0073 covers cardiac event monitors (external loop recorders, mobile cardiovascular telemetry, implantable loop recorders, and long-term >48-hour external ECG/patch monitors such as the Zio Patch) chiefly to document or evaluate suspected arrhythmias, syncope/presyncope, palpitations, ischemia, drug-therapy or post-ablation response, and cryptogenic-stroke atrial fibrillation. The central gate is that infrequent symptoms (less than daily) or a prior non-diagnostic Holter/48-hour telemetry must justify the longer or implantable monitoring, with specific HATCH-score thresholds for ILR AF surveillance. Named consumer/self-monitoring ECG devices (e.g., Kardia, Biotronik BioMonitor, CardioPatch, BodyGuardian, iHEART, ViSi) and indications beyond those listed are considered experimental/investigational or not medically necessary. Coverage criteria include: External intermittent cardiac event monitors (external loop recorders) are covered for ANY ONE of the following: (a) to document a suspected arrhythmia in persons with a non-diagnostic Holter monitor or 48-hour telemetry (e.g., suspected atrial fibrillation as cause of cryptogenic stroke), OR in persons whose symptoms occur infrequently (less frequently than daily); (b) to document ST segment depression for suspected ischemia; (c) to document the benefit after initiating drug therapy for an arrhythmia; (d) to document the recurrence of an arrhythmia after discontinuation of drug therapy; (e) to document the results after an ablation procedure for arrhythmia; (f) to evaluate syncope and lightheadedness in persons with a non-diagnostic Holter monitor or 48-hour telemetry, OR in persons whose symptoms occur infrequently (less frequently than daily).; Mobile cardiovascular telemetry (MCT) is covered when EITHER of the following is met: (1) Evaluation of recurrent unexplained episodes of presyncope, syncope, palpitations or dizziness when BOTH of the following are met: (a) a cardiac arrhythmia is suspected as the cause of the symptoms, AND (b) the member has a non-diagnostic Holter monitor or 48-hour telemetry, OR symptoms occur infrequently (less frequently than daily); OR (2) Evaluation of members with suspected atrial fibrillation as a cause of cryptogenic stroke who have had a non-diagnostic Holter monitor or 48-hour telemetry.; Implantable loop recorder (ILR) is covered for evaluation of recurrent unexplained episodes of pre-syncope, syncope, 'seizures', palpitations, or dizziness when BOTH of the following are met: (a) a cardiac arrhythmia is suspected as the cause of the symptoms, AND (b) the member has a non-diagnostic external monitor, OR symptoms occur infrequently such that the arrhythmia is unlikely to be diagnosed by external monitoring.; Implantable loop recorder (ILR) is covered for evaluation of members with suspected atrial fibrillation as a cause of cryptogenic stroke who have had a non-diagnostic 30-day external mobile cardiovascular telemetry with electrocardiographic recording (mobile cardiac telemetry, MCT).; Implantable loop recorder (ILR) is covered for surveillance for atrial fibrillation in EITHER of the following circumstances: (a) after ablation of typical atrial flutter (cavotricuspid isthmus), in members with a HATCH score of at least 2; OR (b) after a single occurrence of atrial fibrillation during hospitalization for an acute illness or surgery, in a member with a HATCH score of at least 2.; Removal of an implantable loop recorder (ILR) when it has reached end-of-life is considered medically necessary and can be approved; however, reimplantation of another ILR must meet a new indication of the aforementioned medically necessary indications to be approved.; Long-term (greater than 48 hours) external ECG monitoring with continuous rhythm recording and storage (e.g., Zio Patch) is covered to evaluate syncope and lightheadedness in persons with a non-diagnostic Holter monitor or 48-hour telemetry, OR in persons whose symptoms occur infrequently (less frequently than daily) such that the arrhythmia is unlikely to be diagnosed by Holter monitoring.; Long-term (greater than 48 hours) external ECG monitoring with continuous rhythm recording and storage (e.g., Zio Patch) is covered to document an arrhythmia in persons with a non-diagnostic Holter monitor or 48-hour telemetry, OR in persons whose symptoms occur infrequently (less frequently than daily) such that the arrhythmia is unlikely to be diagnosed by Holter monitoring.. Applies to 1 code: 33285. Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: Documentation of a prior non-diagnostic Holter monitor or 48-hour telemetry (or 30-day external MCT for ILR in cryptogenic stroke) is referenced as a prerequisite for multiple covered indications; For ILR atrial fibrillation surveillance after ablation of typical atrial flutter or after a single AF occurrence during hospitalization, documentation of a HATCH score of at least 2 is required. Policy exclusions and limitations: Aetna considers external loop recorders (external intermittent cardiac event monitors) experimental, investigational, or unproven for all other indications because their effectiveness for indications other than the ones listed above has not been established.; Aetna considers mobile cardiovascular telemetry (MCT) experimental, investigational, or unproven for other indications because its effectiveness for indications other than the ones listed above has not been established.; Aetna considers implantable loop recorders not medically necessary for all other indications, including monitoring for residual atrial fibrillation burden, because their effectiveness for indications other than the ones listed above has not been established.; If a loop recorder was implanted for cryptogenic stroke and shows no significant arrhythmia during its full lifespan, another loop recorder for workup of the same event is not considered medically necessary.; Zio Patch for documentation of responses following initiation of drug therapy for arrhythmia is considered experimental, investigational, or unproven.; The following are considered experimental, investigational, or unproven because their clinical value has not been established (not an all-inclusive list): Biotronik BioMonitor.; Experimental, investigational, or unproven (clinical value not established): CardioPatch.; Experimental, investigational, or unproven (clinical value not established): Kardia Mobile (previously known as AliveCore Mobile ECG, AliveCor Heart Monitor (iPhoneECG)), Kardia 12L ECG System, and KardiaMobile 6L.; Experimental, investigational, or unproven (clinical value not established): Mobile patient management systems (e.g., BodyGuardian Remote Monitoring System, and iHEART).; Experimental, investigational, or unproven (clinical value not established): Self-monitoring ECG technologies or the ViSi Mobile Monitoring System.; Requests for cardiac event monitoring that do not meet the medical necessity criteria, and requests for repeat studies within 1 year of a previous study, are subject to medical necessity review. Claims may be denied when the requested service falls under these.

Does Aetna require prior authorization for Cardiac Event Monitors?

Confirm prior-authorization status with Aetna before scheduling — it is code- and plan-specific, and this policy is not an exact authorization source. Documentation: Documentation of a prior non-diagnostic Holter monitor or 48-hour telemetry (or 30-day external MCT for ILR in cryptogenic stroke) is referenced as a prerequisite for multiple covered indications; For ILR atrial fibrillation surveillance after ablation of typical atrial flutter or after a single AF occurrence during hospitalization, documentation of a HATCH score of at least 2 is required.

What does Aetna exclude for Cardiac Event Monitors?

Policy exclusions and limitations: Aetna considers external loop recorders (external intermittent cardiac event monitors) experimental, investigational, or unproven for all other indications because their effectiveness for indications other than the ones listed above has not been established.; Aetna considers mobile cardiovascular telemetry (MCT) experimental, investigational, or unproven for other indications because its effectiveness for indications other than the ones listed above has not been established.; Aetna considers implantable loop recorders not medically necessary for all other indications, including monitoring for residual atrial fibrillation burden, because their effectiveness for indications other than the ones listed above has not been established.; If a loop recorder was implanted for cryptogenic stroke and shows no significant arrhythmia during its full lifespan, another loop recorder for workup of the same event is not considered medically necessary.; Zio Patch for documentation of responses following initiation of drug therapy for arrhythmia is considered experimental, investigational, or unproven.; The following are considered experimental, investigational, or unproven because their clinical value has not been established (not an all-inclusive list): Biotronik BioMonitor.; Experimental, investigational, or unproven (clinical value not established): CardioPatch.; Experimental, investigational, or unproven (clinical value not established): Kardia Mobile (previously known as AliveCore Mobile ECG, AliveCor Heart Monitor (iPhoneECG)), Kardia 12L ECG System, and KardiaMobile 6L.; Experimental, investigational, or unproven (clinical value not established): Mobile patient management systems (e.g., BodyGuardian Remote Monitoring System, and iHEART).; Experimental, investigational, or unproven (clinical value not established): Self-monitoring ECG technologies or the ViSi Mobile Monitoring System.; Requests for cardiac event monitoring that do not meet the medical necessity criteria, and requests for repeat studies within 1 year of a previous study, are subject to medical necessity review. Claims may be denied when the requested service falls under these.

Source

Related

• All Aetna coverage policies
• Aetna prior-authorization requirements — which codes need PA, by CPT