The implantation and removal of a cardiac loop recorder (33282, 33284) is eligible for payment when reported for the following conditions:

• palpitations (785.1)
• dizziness (780.4)
• syncope and collapse (780.2), and
• other transient symptoms which could be due to arrhythmia (426.82, 426.9, 427.60, 427.89, 427.9)

In addition, the electronic analysis of the implantable loop recorder system should be reported under code 93727. This diagnostic service includes the retrieval of recorded and stored ECG/EKG data, the interpretation of the data, and reprogramming of the recorder. Payment for this electronic analysis should be allowed only once in a thirty-day period regardless of the number of events of recordings which have occurred. Charges for electronic analysis billed more frequently within the thirty-day period are not eligible for separate payment. A participating, preferred, or network provider cannot bill the patient separately for additional electronic analysis services during the thirty-day period.

When reported for indications other than those listed above, these procedures are considered not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service.

Description

The implantable cardiac loop recorder is a patient-activated monitoring system that permits long-term monitoring of arrhythmias in patients with recurrent but infrequent symptoms.

The device is a programmable cardiac event recorder with a looping memory and is implanted just beneath the patient's skin in the chest area. When symptoms are experienced, the patient places a hand-held activator over the recorder to activate the storage of cardiac rhythms. This device can be used for more than one year. The use of this monitoring system is considered to be medically necessary only in a small subset of patients who experience symptoms so infrequently that a prolonged period of cardiac monitoring (greater than one month) is anticipated.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

Ambulatory Event Monitors, Consortium Health Plans, Inc., Policy 2.02.08, 5/2006

Implantable Cardiac Arrhythmia Devices - Part II: Implantable Cardioverter Defibrillator and Implantable Loop Recorders, Clinical Cardiology, Vol. 29, 2006

The Utility of Implantable Loop Recorders for Diagnosing Unexplained Syncope in 100 Consecutive Patients - Five-Year, Single Center Experience, The Journal of Invasive Cardiology, Vol. 18, No. 7, July 2006

Early Application of an Implantable Loop Recorder Allows Effective Specific Therapy in Patients with Recurrent Suspected Neurally Mediated Syncope, European Heart Journal, Vol. 27, 2006