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Blue Shield of CaliforniaAll Plans · Coverage · Medical Policy · CA · Cardiology, NeurologyHigh impact

Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry (2.02.08)

Effective date
Aug 1, 2026
Identified
Jul 31, 2026

Summary

Blue Shield of California medical policy 2.02.08, Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry, has an effective date of August 1, 2026. Outpatient cardiac telemetry (mobile cardiac outpatient telemetry, MCOT) may be considered medically necessary as a diagnostic alternative to ambulatory event monitors for infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias, such as severe palpitations, dizziness, or clinically significant presyncope or syncope, when the criteria below are met. Under the prior policy statement this use was considered investigational. Outpatient cardiac telemetry for any other condition, disease or symptoms, and ambulatory event monitors for asymptomatic individuals with risk factors for arrhythmia, are considered investigational.

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What to do

Action · 6 steps
01Already effective August 1, 2026: For mobile cardiac outpatient telemetry (codes 93228 and 93229), confirm that one of the policy criteria is met before billing.
02Criterion 1: recurrent unexplained clinically significant presyncope, syncope, severe palpitations or dizziness, when symptoms are thought to be due to a cardiac arrhythmia as the most likely diagnosis, a Holter monitor and/or external AEM has been nondiagnostic or contraindicated, and the record documents that real-time monitoring is essential for patient safety and will lead to immediate clinical changes such as medication or other emergent procedures.
03Criterion 2: evaluation of cryptogenic stroke thought to be caused by atrial fibrillation, with a non-diagnostic 24- to 48-hour Holter monitor or 48-hour telemetry.
04Documentation for clinical review should include a history and physical and/or cardiology consultation report with the clinical justification for the device, a description and frequency of symptoms, the device name and type including vendor name, documentation of a prior Holter or external ambulatory event monitor trial when applicable, and, when atrial fibrillation applies, past catheter ablation history and anticoagulation status with any plan for discontinuation.
05After service, provide the ambulatory monitor report.
06Questions about applicability go to the Prior Authorization Department at (800) 541-6652.

Codes mentioned

9322893229R00.2R42R55I63.9

Original notice

Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry (2.02.08)
blueshieldca.com · Always check the source before changing claims.
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Related policy hubs

Blue Shield of California policiesCA policy changesCardiologyNeurologyCode 93228Code 93229Code R00.2Code R42Code R55Code I63.9

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