Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A57326 (Billing and Coding: Electrocardiograms) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A57326: Billing and Coding: Electrocardiograms (Billing and Coding, effective 2025-11-06)
- Covered ICD-10-CM codes
- 2739
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 6
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| A01.01 | — |
| A01.02 | — |
| A01.03 | — |
| A01.04 | — |
| A01.05 | — |
| A01.09 | — |
| A02.1 | — |
| A05.1 | — |
| A17.83 | — |
| A17.89 | — |
| A18.82 | — |
| A18.84 | — |
| A18.89 | — |
| A19.0 | — |
| A19.1 | — |
| A19.8 | — |
| A20.7 | — |
| A22.7 | — |
| A26.7 | — |
| A32.7 | — |
| A36.81 | — |
| A39.2 | — |
| A39.3 | — |
| A39.50 | — |
Procedure codes: 93000, 93005, 93010, 93040, 93041, 93042.
Coverage indications, limitations and medical necessity
The electrocardiogram (ECG, EKG) and ECG rhythm strip records the electrical activity of the heart throughout the cardiac cycle of contraction (depolarization) and relaxation (repolarization). The changes in electrical potential during the cardiac cycle are detected at the body surface and recorded on graph paper. The recording is reviewed by a physician who provides an interpretation and written report. An ECG may be reported as the technical aspect only, the interpretation and written report only, or both aspects together as one service.
The electrical activity of the heart can be viewed along various electrical axes (viewpoints). Each viewpoint is described as a "lead”. A typical ECG views the heart from 12 axes and, therefore, has 12 leads. A rhythm strip typically includes one to three leads. Typically, a 12-lead ECG is a separate document from the medical progress notes, while a printed rhythm strip may be pasted into the progress notes.
An ECG is indicated to diagnose or treat a patient for symptoms, signs, or a history of heart disease; or systemic conditions that affect the heart, including:
• Chest pain or angina pectoris,
• Myocardial ischemia or infarction,
• Arteriovascular disease including coronary, central, and peripheral disease,
• Hypertension,
• Conduction abnormalities,
• Cardiac rhythm disturbances,
• Cardiac hypertrophy,
• Heart failure,
• Pericarditis,
• Structural cardiac conditions,
• Endocrine abnormalities,
• Neurological disorders affecting the heart,
• Syncope,
• Paroxysmal weakness,
• Palpitations,
• Sudden lightheadedness,
• Electrolyte imbalance,
• Acid-base disorders,
• Temperature disorders,
• Pulmonary disorders, and
• Drug cardiotoxicity.
An ECG may help identify cardiac disorders as part of a preoperative clinical evaluation. A preoperative ECG may be reasonable and necessary under one of the following conditions:
• In the presence of pre-existing heart disease such as congestive heart failure, prior myocardial infarction (MI), angina, coronary artery disease, or dysrhythmias;
• In the presence of known comorbid conditions that may affect the heart, such as chronic pulmonary disease, peripheral vascular disease, diabetes, or renal impairment; or
• When the pending surgery requires a general or regional anesthetic.
Summary of evidence (opening)
NA
the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2025-11-06
- Last reviewed by the contractor
- 2021-03-02
- MCD version
- 41
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Noridian Healthcare Solutions, LLC hub lists every other active policy from the same contractor.
Frequently asked questions
What does LCD L34315 cover?
The electrocardiogram (ECG, EKG) and ECG rhythm strip records the electrical activity of the heart throughout the cardiac cycle of contraction (depolarization) and relaxation (repolarization). The changes in electrical potential during the cardiac cycle are detected at the body surface and recorded on graph paper. The recording is reviewed by a physician who provides an interpretation and written report. An ECG may… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L34315 apply to?
Noridian Healthcare Solutions, LLC applies it to Medicare claims in AK, AS, AZ, CA, CNMI, GU, HI, ID, MT, ND, NF, NV, OR, SD, SF, UT, WA, WY. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L34315?
The companion billing and coding article A57326 lists 2,739 ICD-10-CM codes in 1 group that support medical necessity; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L34315?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.