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Electrocardiogram (ECG) wearables prior authorization

Updated: Jul 21, 2023

electrocardiogram (ECG) wearables are effective surveillance devices in monitoring arrhythmias or coronary artery disease. Under what conditions, are these wearable devices covered by insurance?

Is Preauth Required?

Preauthorization may be required for electrocardiogram (ECG) wearable treatment for conditions such as angina pectoris with documented spasm, other acute ischemic heart diseases, dilated cardiomyopathy, other hypertrophic cardiomyopathy, atrioventricular and left bundle-branch block, other conduction disorders, paroxysmal tachycardia, atrial fibrillation and flutter, other cardiac arrhythmias, cerebral infarction, sequelae of cerebral infarction, congenital heart block, other specified congenital malformations of heart, abnormalities of heart beat, dyspnea, pain in throat and chest, dizziness and giddiness, syncope and collapse, encounter for adjustment and management of cardiac pacemaker, encounter for adjustment and management of automatic implantable cardiac defibrillator, personal history of transient ischemic attack (TIA) and cerebral infarction without residual deficits, and presence of cardiac pacemaker and automatic (implantable) cardiac defibrillator.

When is the following treatment medically necessary for the condition specified?

Electrocardiogram (ECG) wearable is considered medically necessary for the following clinical situations: monitoring effectiveness of antiarrhythmic therapy and detection of myocardial ischemia by detecting ST segment changes, following catheter or surgical ablation of atrial fibrillation, monitoring for the presence of atrial fibrillation in individuals with cryptogenic stroke when the criteria are not met. The CPT codes 93224, 93225, 93226, and 93227 and ICD-10 codes I20.1, I20.9, I24.0-I24.9, I42.0, I42.1, I42.2, I44.0-I45.9, I47.0-I49.9, I63.9, I69.30-I69.398, Q24.6, Q24.8, R00.0-R00.9, R06.00-R06.09, R07.1-R07.9, R42, R55, Z45.010-Z45.018, Z45.02, Z86.73, Z95.0, Z95.810


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