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 A57476 (Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)) 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.
A57476: Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) (Billing and Coding, effective 2026-10-01)
- Covered ICD-10-CM codes
- 159
- 3 groups
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 18
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| G45.0 | — |
| G45.1 | — |
| G45.2 | — |
| G45.3 | — |
| G45.4 | — |
| G45.8 | — |
| G45.9 | — |
| I20.0 | — |
| I20.1 | — |
| I20.81 | — |
| I20.89 | — |
| I21.01 | — |
| I21.02 | — |
| I21.09 | — |
| I21.11 | — |
| I21.19 | — |
| I21.21 | — |
| I21.29 | — |
| I21.4 | — |
| I21.9 | — |
| I21.A1 | — |
| I21.A9 | — |
| I22.0 | — |
| I22.1 | — |
Procedure codes: 93224, 93225, 93226, 93227, 93228, 93229, 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, 93268, 93270, 93271, 93272.
Coverage indications, limitations and medical necessity
Long-Term ECG Monitoring is defined as a diagnostic procedure, which can provide continuous recording capabilities of ECG activities of the patient's heart while the patient is engaged in daily activities. These can include continuous, patient-demand or auto-detection devices. The purpose of these tests is to provide information about rhythm disturbances and waveform abnormalities and to note the frequency of their occurrence.
Cardiac Event Detection (CED) is a 30-day service for the purpose of documentation and diagnosis of paroxysmal or suspected arrhythmias.
Holter Monitoring (24-hour ECG monitoring) is a study used to evaluate the patient's ambient heart rhythm during a full day's (24 Hours) cycle. It is a wearable EKG monitor that records the overall rhythm and significant arrhythmias.
• Medical Necessity:
The medical necessity indications listed in this policy must be present in order for these tests to be covered.
• Indications for external 48-hour ECG recording include 1 or more of the following:
• Symptoms:
• Arrhythmias
• Chest pain
• Syncope (lightheadedness) or near syncope
• Vertigo (dizziness)
• Palpitations
• Transient ischemic episodes
• Dyspnea (shortness of breath)
• Evaluation of the response to antiarrhythmic drug therapy.
• Evaluation of myocardial infarction (MI) survivors with an ejection fraction of 40% or less.
• Assessment of patients with coronary artery disease with active symptoms, to correlate chest pain with ST-segment changes.
• Other acute and subacute forms of ischemic heart disease.
• To detect arrhythmias post ablation procedures.
• The use of external electrocardiographic recording for greater than 48 hours and up to 7 days or for greater than 7 days up to 15 days by continuous rhythm recording and storage, may be considered medically necessary in patients treated for reasons listed in the diagnosis list to monitor for asymptomatic episodes in order to evaluate treatment response. The use of external electrocardiographic event monitors for greater than 48 hours and up to 7 days or for greater than 7 days up to 15 days that are either patient-activated or auto-activated may be considered medically necessary as a diagnostic alternative to Holter monitoring in patients who experience infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias (i.e., palpitations, dizziness, presyncope, or syncope). (Refer to current CPT codebook)
• Long term 30-day monitoring: Telephonic Transmission of ECG involves 24 hour attended monitoring per 30-day period of time; no other EKG monitoring codes can be billed simultaneously with these codes.
Indications for performing a Telephonic Transmission:
• Arrhythmias
• Chest pain
• Syncope (lightheadedness) or near syncope
• Vertigo (dizziness)
• Palpitations
• Transient ischemic episodes
• Dyspnea (shortness of breath)
• To initiate, revise or discontinue arrhythmia drug therapy.
• Evaluation of myocardial infarction (MI) survivors.
• Evaluation of acute and subacute forms of ischemic heart disease.
• Assessment of patients with coronary artery disease with active symptoms, to correlate chest pain with ST-segment changes.
Summary of evidence (opening)
N/A
The contractor cites 3 sources in the bibliography; 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
- 2025-08-28
- Last reviewed by the contractor
- 2025-07-21
- MCD version
- 38
- Derived from
- L29584
The contractor lists one National Coverage Determination as related: NCD 20.15 Electrocardiographic Services. Where an NCD speaks, it controls; the LCD can only address what the NCD leaves open.
Other related documents: A54953 (Article).
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 Wisconsin Physicians Service Insurance Corporation hub lists every other active policy from the same contractor.
Frequently asked questions
What does LCD L34636 cover?
Long-Term ECG Monitoring is defined as a diagnostic procedure, which can provide continuous recording capabilities of ECG activities of the patient's heart while the patient is engaged in daily activities. These can include continuous, patient-demand or auto-detection devices. The purpose of these tests is to provide information about rhythm disturbances and waveform abnormalities and to note the frequency of their… 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 L34636 apply to?
Wisconsin Physicians Service Insurance Corporation applies it to Medicare claims in AK, AL, AR, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, 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 L34636?
The companion billing and coding article A57476 lists 159 ICD-10-CM codes in 3 groups 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 L34636?
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.