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Medical Policy Upcoming Updates

Notification Date: March 18, 2020

Below are the policies that are new or have been reviewed, along with the determination and summary of any changes.

Coverage Policies

Policy Title
Effective Date
Summary of Change
Cardiac Event Monitors New composite policy 05/18/2020 Covered for some indications; investigative and therefore not covered for all other indications New Determination:
1. Implantable Loop Cardiac Recorders:
Covered for:
a. Unexplained symptoms suggestive of cardiac arrhythmias (e.g., unexplained syncope, presyncope, palpitations, or dizziness)
b. Post-cardiac ablation monitoring
c. History of cryptogenic stroke or transient ischemic attach (TIA) with suspected unconfirmed occult atrial fibrillation.
Investigative and not covered for all other indications.

Grandfathered into this policy as covered:
1. Holter monitor
2. External loop recorder/External intermittent cardiac event monitor.

Incorporated into this policy as covered and previous coverage policy inactivated:
1. Patch cardiac rhythm monitor (previously titled Long-Term Ambulatory Cardiac Rhythm Monitors)

Incorporated into this policy and refers the reader to the associated Utilization Management Policy:
1. Real-Time Mobile Cardiac Outpatient Telemetry

The updated clinical policies and guidelines above will be available as of their effective date, as noted. View policies and guidelines.

To request paper copies of a policy, please leave a message at the Medica Provider Literature Request Line: 1-800-458-5512, option 1, then option 8, then ext. 2-2355.

Where information conflicts with applicable state and/or federal law, Medica follows such applicable federal and/or state law.

Date: 7/31/2021 10:44:56 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB02