MedicaidCoverageMedium impact
Cardiac Devices - MEDICAID - ILLINOIS (New)
Humana·IL · Cardiology, Internal Medicine·Medicaid
Effective date
Oct 28, 2026
We identified it
Oct 26, 2026
Summary
Humana Illinois Medicaid has established new coverage policy for Mobile Cardiac Outpatient Telemetry (MCOT) effective 2026-10-28. The policy covers real-time continuous attended cardiac monitoring (CPT 93228, 93229) for members with infrequent/unpredictable symptoms and either recurrent unexplained syncope with suspected arrhythmic etiology or suspected paroxysmal atrial fibrillation as cause of cryptogenic stroke. For members under age 21, medical necessity reviews must comply with EPSDT requirements.
Action Required
Effective 2026-10-28: Billing team should implement coverage authorization for CPT codes 93228 and 93229 in the billing system for Illinois Medicaid members. Ensure prior authorization or medical necessity review processes are updated to reflect the two covered indications: (1) recurrent unexplained syncope with suspected arrhythmic etiology when initial evaluation is nondiagnostic, OR (2) suspected paroxysmal atrial fibrillation as cause of cryptogenic stroke when monitoring will guide anticoagulation. For members under age 21, implement EPSDT medical necessity review requirements. Verify that claims for these codes without documented medical necessity for these specific indications will require denial or rework per coverage criteria.