MedicaidCoverageMedium impact
Cardiac Devices - MEDICAID - MICHIGAN (Revised)
Humana·MI · Cardiology, Internal Medicine·Medicaid
Effective date
Oct 28, 2026
We identified it
Oct 26, 2026
Summary
Humana Michigan Medicaid revised its cardiac devices policy effective 2026-10-28, updating coverage criteria for mobile cardiac outpatient telemetry (MCOT) monitoring. The policy now specifies two approved indications: recurrent unexplained syncope with suspected arrhythmic etiology, and suspected paroxysmal atrial fibrillation as a cause of cryptogenic stroke. CPT codes 93228 and 93229 remain the applicable billing codes for this service.
Action Required
Effective 2026-10-28: Billing team and clinical staff should verify that authorization requests and claims submission for MCOT services (CPT 93228, 93229) under Michigan Medicaid now require documentation of one of the two specified indications: (1) infrequent or unpredictable symptoms with recurrent unexplained syncope and suspected arrhythmic etiology, OR (2) suspected paroxysmal atrial fibrillation as cause of cryptogenic stroke. Update pre-authorization templates and clinical documentation requirements in the billing system to align with these coverage criteria. For members under age 21, continue to ensure requests are reviewed for medical necessity under EPSDT requirements. Confirm current applicability with Humana Michigan Medicaid plan documents, as individual member coverage may differ from this policy.