Close Window
Aetna.com Home    |     Help    |     Contact Us

Search  
Aetna Aetna
Clinical Policy Bulletin:
Holter Monitors
Number: 0019


Policy

Aetna considers Holter monitoring medically necessary for diagnostic evaluation of members with any of the following symptoms or conditions:

  1. Symptoms related to rhythm disturbances (e.g., frequent palpitation, syncope, unexplained dizziness, frequent arrhythmias); or
  2. Autonomic cardiac neuropathy associated with diabetes mellitus; or
  3. Idiopathic hypertrophic or dilated cardiomyopathy; or
  4. Post myocardial infarction with left ventricular dysfunction; or
  5. As a method to assess treatment effectiveness in individuals with baseline high frequency, reproducible, sustained, symptomatic premature ventricular complexes, supraventicular arrhythmias or ventricular tachycardia; or
  6. In individuals with pacemakers to assess paroxysmal symptoms, myopotential inhibition, pacemaker medicated tachycardia, antitachycardia pacing device functioning, rate-responsive physiologic pacing function; or
  7. Individuals with pain suggestive of Prinzmetal's angina.

Aetna considers Holter monitoring experimental and investigational for all other indications.

Note: Digitalization and/or color display of results are considered incidental features of Holter monitoring.

Note: Holter monitoring lasting more than 48 hours is generally considered not medically necessary. The literature indicates that if more frequent monitoring is needed to evaluate arrhythmias, use of cardiac event recorders should be considered. See CPB 073 - Cardiac Event Monitors.

Note: Routine performance of Holter monitoring has no proven benefit for individuals who are undergoing sleep studies for suspected obstructive sleep apnea.

Note: For Aetna's policy on home-based real-time cardiac surveillance systems (e.g., CardioNet Mobile Outpatient Cardiac Telemetry Service, Cardiac Telecom Telemetry @ Home Service), see CPB 073 - Cardiac Event Monitors.



Background

A Holter monitor is a self-contained ambulatory and recording device used to capture continuous electrocardiographic measurements over a period of 24 to 48 hours. Holter monitors must be distinguished from ambulatory event monitors, which capture episodic electrocardiographic data over large periods of time, up to 1 month.

Electrodes are placed on the patient's chest and attached to a small recording monitor that the patient carries in a pocket or in a small pouch. The monitor is battery operated. A continuous electrocardiogram is recorded on a cassette tape, usually for a 24-hour period, while the patient keeps a diary of activities. The recording is then analyzed, a report of the heart's activity is tabulated, and irregular heart activity is correlated with the patient's activity at the time.

Advanced Holter monitors have been developed that employ digital electrocardiographic recordings, extended memory greater than 24 hours, pacemaker pulse detection and analysis, software for analysis of digital ECG recordings that are downloaded and stored on a computer, and capability of transmission of results over the internet (see e.g., Raytel Medical Corporation, 2004; MIDMARK Diagnostics Group, 2004; Integrated Medical Devices, 2003).
 
CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes covered if selection criteria are met:
93224
93225
93226
93227
93230
93231
93232
93233
93235
93236
93237
HCPCS codes not covered for indications listed in the CPB:
S0345 Electrocardiographic monitoring utilizing a home computerized telemetry station with automatic activation and real-time notification of monitoring station, 24-hour attended monitoring, including recording, monitoring, receipt of transmissions, analysis, and physician review and interpretation; per 24 hour period
S0346 Electrocardiographic monitoring utilizing a home computerized telemetry station with automatic activation and real-time notification of monitoring station, 24-hour attended monitoring, including recording, monitoring, receipt of transmissions, and analysis; per 24-hour period
S0347 Electrocardiographic monitoring utilizing a home computerized telemetry station with automatic activation and real-time notification of monitoring station, 24-hour attended monitoring, including physician review and interpretation; per 24-hour period
ICD-9 codes covered if selection criteria are met:
250.60 - 250.63 Diabetes with neurological manifestations
306.2 Cardiovascular malfunction arising from mental factors
337.1 Peripheral autonomic neuropathy in disorders classified elsewhere
410.00 - 412 Myocardial infarction
413.1 Prinzmetal angina
425.1 Hypertrophic obstructive cardiomyopathy
425.4 Other primary cardiomyopathies
426.0 - 426.9 Conduction disorders
427.0 - 427.9 Cardiac dysrhythmias
435.0 - 435.9 Transient cerebral ischemia
780.2 Syncope and collapse
780.4 Dizziness and giddiness
785.1 Palpitations
V45.01 Cardiac pacemaker in situ
ICD-9 codes not covered for indications listed in the CPB:
327.00 - 327.8 Organic sleep disorders [if undergoing sleep studies for suspected obstructive sleep apnea]
780.50 - 780.59 Sleep disturbances [if undergoing sleep studies for suspected obstructive sleep apnea]
786.03 Apnea [if undergoing sleep studies for suspected obstructive sleep apnea]
786.09 Other dyspnea and respiratory abnormality [if undergoing sleep studies for suspected obstructive sleep apnea]


The above policy is based on the following references:
  1. Linzer M, Yang EH, Estes NA 3rd, et al. Diagnosing syncope. Part 1: Value of history, physical examination, and electrocardiography. Clinical Efficacy Assessment Project of the American College of Physicians. Ann Intern Med. 1997;126(12):989-996.
  2. Linzer M, Yang EH, Estes NA 3rd, et al. Diagnosing syncope. Part 2: Unexplained syncope. Clinical Efficacy Assessment Project of the American College of Physicians. Ann Intern Med. 1997;127(1):76-86.
  3. Hayakawa H, Saitoh H. Advances in the diagnosis of arrhythmia Holter's ECG. Nippon Rinsho. 1996;54(8):2085-2090.
  4. Lantz DA. Efficacy of Holter monitors. Ann Intern Med. 1996;125(8):697-698.
  5. Sovova E, Doupal V, Lukl J. New trends in ECG Holter monitoring. Vnitr Lek. 1996;42(6):386-389.
  6. Farrehi PM, Santinga JT, Eagle KA. Syncope: Diagnosis of cardiac and noncardiac causes. Geriatrics. 1995;50(11):24-30.
  7. Wilson AC, Kostis JB. Duration of Holter monitoring. Am J Cardiol. 1994;74(3):308.
  8. Nakanishi T, Yoshimura M. Recent progress in Holter electrocardiography, focussed on heart rate variability. Rinsho Byori. 1993;41(11):1206-1213.
  9. DiMarco JP, Philbrick JT. Use of ambulatory electrocardiographic (Holter) monitoring. Ann Intern Med. 1990;113(1):53-68.
  10. McClennen S, Zimetbaum PJ, Ho KK, Goldberger AL. Holter monitoring: Are two days better than one? Am J Cardiol. 2000;86(5):562-564. 
  11. Crawford MH, Bernstein SJ, Deedwania PC, et al. ACC/AHA guidelines for ambulatory electrocardiography: Executive summary and recommendations. A report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 1999;100(8):886-893.
  12. Sivakumaran S, Krahn AD, Klein GJ, et al. A prospective randomized comparison of loop recorders versus Holter monitors in patients with syncope or presyncope. Am J Med. 2003;115(1):1-5.
  13. Raytel Medical Corporation. Holter monitoring [website]. Raytel Cardiac Services. Turnersville, NJ: Raytel Diagnostic Services; 2004. Available at: http://www.raytel.com/Content.asp?CategoryID=27&CurrentID=123. Accessed January 11, 2005.
  14. MIDMARK Diagnostics Group. IQmark Advanced Holter Monitor. Torrance, CA: MIDMARK; 2004 Available at: http://midmarkdiagnostics.com/noflash/advance_holter.html. Accessed January 11, 2005.
  15. Integrated Medical Devices, Inc. Holter monitoring [website]. Liverpool, NY: Integrated Medical Devices; 2003. Available at: http://www.integrated-medical.com/holter.html. Accessed January 11, 2005.
  16. Scalvini S, Zanelli E, Martinelli G, et al. Cardiac event recording yields more diagnoses than 24-hour Holter monitoring in patients with palpitations. J Telemed Telecare. 2005;11 Suppl 1:14-16.
  17. British Columbia Ministry of Health, Guidelines and Protocols Advisory Committee. Ambulatory ECG Monitoring (Holter Monitor and Patient-Activated Event Recorder). Victoria, BC: British Columbia Ministry of Health; revised 2004. Available at: http://www.healthservices.gov.bc.ca/msp/protoguides. Accessed January 18, 2006.
  18. Aronow WS. Heart disease and aging. Med Clin North Am. 2006;90(5):849-862.
  19. Rajagopalan K, Potts JE, Sanatani S. Minimally invasive approach to the child with palpitations. Expert Rev Cardiovasc Ther. 2006;4(5):681-693.
  20. Gibson CM, Ciaglo LN, Southard MC, et al. Diagnostic and prognostic value of ambulatory ECG (Holter) monitoring in patients with coronary heart disease: A review. J Thromb Thrombolysis. 2007;23(2):135-145.


email this page   


Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
CPT only copyright 2006 American Medical Association. All Rights Reserved.
Aetna
Back to top