April 2, 2008
Mobile Cardiac Outpatient Telemetry Billing (Revised)
Guidelines including pricing for the above service were posted on the CIGNA Government Services website 121004. It incorrectly stated reimbursement would be based on CPT code 93732 (ELECTRONIC ANALYSIS OF DUAL-CHAMBER INTERNAL PACEMAKER SYSTEM (MAY INCLUDE RATE, PULSE AMPLITUDE AND DURATION, CONFIGURATION OF WAVE FORM, AND/OR TESTING OF SENSORY FUNCTION OF PACEMAKER); WITH REPROGRAMMING). Instead, reimbursement will be based on CPT code 93272 (Patient demand single or multiple event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; physician review and interpretation only). The article is being republished in its entirety as follows to include this correction, and to clarify the date of service to be used to bill for the professional component.
Mobile Cardiac Outpatient Telemetry (MCOT) is real-time, outpatient cardiac monitoring system that is automatically activated and requires no patient intervention to either capture or transmit an arrhythmia when it occurs. Upon arrhythmia detection, the ECG waveform is transmitted by standard telephone line or wireless communications to the Pennsylvania receiving center monitoring the patient and reporting significant findings according to the physician’s patient-specific, pre-determined criteria.
At this point in time, there is no assigned CPT code for this service, nor is there a Local or National Coverage Decision (LCD or NCD) that specifically addresses this procedure. Providers rendering this service should know and follow these guidelines:
- The service is evaluated individually in absence of LCD/NCD. Where the equivalence or superiority of a new service over existing technologies is not corroborated in reputable peer reviewed literature, the service may be considered as investigational and not payable by Medicare.
- Assuming medical necessity criteria have been met, the physician service (interpretation) associated with this should be billed with CPT code 93799 with modifier 26 appended.
- No technical component of the service should be billed as this is provided by the centralized monitoring site headquartered in Pennsylvania. Therefore, only the professional component is reimbursable to providers by CIGNA Government Services.
- This service is reimbursable per entire monitoring episode and not per ECG strip or per day. Otherwise stated, reimbursement will be made only once per monitoring episode and will be based on CPT code 93272 (Patient demand single or multiple event recording with pre-symptom memory loop, 24-hour attended monitoring, per 30 day period of time; physician review and interpretation only.)
- Documentation in the medical record should include a formal interpretation and report for the duration of time the device was worn (i.e. episode). This report should be completed as soon as possible after the completion of the entire period of monitoring. (Note: In order for diagnostic services to be payable, they must be promptly used in the diagnosis or treatment of the patient, and completed in a timely manner.)
- When billing the professional component, the physician should use the date of the completion of the last transmission of data from the data center (the end of the monitoring period) as the date of service.
Providers should not submit any medical record documentation with the initial claim. Upon receipt of the claim, CIGNA Government Services will solicit additional documentation, when necessary, by means of an Additional Documentation Request (ADR) letter. Providers who qualify for the exception to bill on paper and elect to do so should insert "MCOT" in Field 19 of Form CMS - 1500. Electronic billers should enter "MCOT" in the NTE segment (notes and comment segment). This is the electronic equivalent for Field 19 of Form CMS - 1500 in HIPAA compliant transactions.
This article supersedes all previous publications on this topic for the CIGNA Government Services jurisdictions.
(Effective 5/1/2008)