Medicare AdvantageCoverageMedium impact
Ambulatory Cardiac Monitoring Devices - Medicare Advantage (Revised)
Humana·Cardiology, Internal Medicine, Emergency Medicine·Medicare Advantage
Effective date
Jun 28, 2026
We identified it
Jul 15, 2026
Summary
This is a revised Medicare Advantage policy on ambulatory cardiac monitoring devices effective 06/28/2026. The policy describes coverage criteria and applicable Local Coverage Determinations (LCDs) by MAC jurisdiction for various cardiac monitoring technologies (Holter monitors, event monitors, implantable loop recorders, and mobile cardiac outpatient telemetry). The document establishes which specific CPT codes and monitoring devices are covered under Medicare Advantage plans.
Action Required
By June 28, 2026, billing and clinical teams must: (1) Review the applicable MAC jurisdiction LCD for your state/region (listed in the Related CMS Documents table) and implement those specific coverage rules; (2) Update billing software and encounter forms to reflect the correct CPT codes (93224-93227 for Holter monitors and applicable codes for other monitoring devices) based on your MAC jurisdiction; (3) Ensure providers document medical necessity aligned with NCD 20.15 and applicable LCD requirements before ordering ambulatory cardiac monitoring; (4) Verify that prior authorization processes comply with your specific MAC's LCD requirements, as they vary by region. Claims submitted without compliance to the applicable MAC LCD may be denied. Coordinate with your cardiovascular/cardiology departments to understand device selection criteria.