Medlearn
Matters…Information for Medicare
Providers
(Issued by the Centers for
Medicare & Medicaid
Services)
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Electrocardiographic Services
Provider Types Affected
Physicians and providers billing Medicare carriers and
fiscal intermediaries (FIs) for electrocardiographic (ECG
or EKG) services
Provider Action Needed
Impact to You
The Centers for Medicare & Medicaid Services (CMS)
nationally covers the use of electrocardiographic (ECG or
EKG) services under specific criteria described in
§20.15, Pub. 100-03, National Coverage
Determinations (NCD) Manual. EKG technologies are now
organized into an updated framework to aid in making
reasonable and necessary coverage determinations as they
pertain to EKG technology. Effective August 26, 2004,
electrocardiographic (EKG) services performed with a
marketed, Food and Drug Administration (FDA)-approved
device, are eligible for coverage if they can be
categorized according to the EKG Services Framework
described in the NCD Manual.
What You Need to Know
Ambulatory cardiac monitoring performed with a marketed,
FDA-approved device is eligible for coverage if it can be
categorized according to the EKG framework. Unless there
is a specific NCD for that device or service,
determination as to whether a device or service that fits
into the framework is reasonable and necessary is at the
discretion of your local carrier or FI.
What You Need to Do
To ensure
accurate claims processing for EKG services, review the
information included here and stay current with
instructions for electrocardiograhic services.
Background
EKG technologies are
now organized into an updated framework to aid in making
reasonable and necessary coverage determinations as they
pertain to EKG technology. Ambulatory cardiac monitoring
performed with a marketed, FDA-approved device is
eligible for coverage if it can be categorized according
to that framework.
The framework is detailed and described in a revised
portion of the NCD manual and that revised portion is
attached to CR 3590. The following table summarizes the
nationally covered indications and nationally noncovered
indications for EKG technologies:
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Nationally Covered Indications
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Nationally Noncovered Indications
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1. Computer analysis of EKGs when furnished in a
setting and under the circumstances required for
coverage of other EKG services.
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1. The time-sampling mode of operation of
ambulatory EKG cardiac event
monitoring/recording.
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2. EKG services rendered by an independent
diagnostic testing facility (IDTF), including
physician review and interpretation. Separate
physician services are not covered unless he/she is
the patient’s attending or consulting
physician.
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2. Separate physician services other than those
rendered by an IDTF unless rendered by the
patient’s attending or consulting
physician.
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3. Emergency EKGs performed as a laboratory or
diagnostic service by a portable x-ray supplier
only when a physician is in attendance at the time
the service is performed or immediately
thereafter.
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3. Emergency EKG services by a portable x-ray
supplier without a physician in attendance at the
time of service or immediately thereafter.
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4. Home EKG services with documentation of
medical necessity.
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4. Home EKG services without documentation of
medical necessity.
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5. Ambulatory cardiac monitoring performed with
a marketed, FDA-approved device is eligible for
coverage if it can be categorized according to the
electrocardiographic services framework of Chapter
1, Section 20.15 of the NCD Manual. Unless there is
a specific NCD for that device or service,
determination as to whether a device or service
that fits into the framework is reasonable and
necessary is according to local contractor
discretion.
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5. Any marketed Food and Drug Administration
(FDA)-approved ambulatory cardiac monitoring device
or service that cannot be categorized according to
the electrocardiographic services framework
discussed in Chapter 1, Section 20.15 of the NCD
manual.
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6. Trans-telephonic EKG transmissions used for
the specific indications, when performed with
specific equipment and subject to the specific
limitations and condition detailed in Chapter 1,
Section 20.15 of the NCD manual.
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6. Twenty-four-hour attended coverage used as
early post-hospital monitoring of patients
discharged after myocardial infarction unless
provided according to specific criteria as
mentioned in Chapter 1, Section 20.15 of the NCD
manual.
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Additional Information
The
official instruction issued to your carrier/intermediary
regarding this change can be found at:
http://www.cms.hhs.gov/Transmittals/
On the above page, scroll down the CR NUM column on
the right to find the link for CR 3590. Click on the link
to open and view the file for the CR.
The revised §20.15, Pub. 100-03, National
Coverage Determinations Manual, is attached to CR
3590.
If you have questions regarding this issue, you may
also contact your carrier or FI at their toll-free
number, which may be found at: http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf
Disclaimer
Medlearn Matters articles are prepared as a service to
the public and are not intended to grant rights or impose
obligations. Medlearn Matters articles may contain
references or links to statutes, regulations, or other
policy materials. The information provided is only
intended to be a general summary. It is not intended to
take the place of either the written law or regulations.
We encourage readers to review the specific statutes,
regulations, and other interpretive materials for a full
and accurate statement of their contents.
Related Change Request (CR) #:
3590
Medlearn Matters Number: MM3590
Related CR Release Date: December 10,
2004
Related CR Transmittal #: 26
Effective Date: August 26,
2004
Implementation Date: December 10, 2004
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