Medicare rebate changes - Cardiac Monitoring Service

Medicare Billing/Reimbursements are now determined by the length of the Holter study.

Rates for Extended Wear Holter (EWH) increased in 2021. The changes to the codes were made in recognition of the associated time and work to monitor, detect and analyze cardiac results over longer periods, which have been shown to increase detection rates.

Extended Wear Holter (EWH) with monitoring lengths of 3-7 days and 8+ days are covered by Medicare.

Since January 2021, Holter services have been catergorized by the length of the Holter test

Up to 48hrs
More than 48hrs, up to 7 days
More than 7 days, up to 15 days

Holter categories and codes

Download CPT code quickguide CPT code quickguide

Medicare changes FAQs

When will the new Holter codes and categories come into play?

The 1st of January 2021

When will the finalized Extended Wear Holter (EWH) rates be published?

As negotiations continue, Cardiac Monitoring Service will update on any changes. For now, Medicare has not published standardized national rates. Check with your local Medicare Administrative Contractor (MAC) for accurate pricing.

Can non-physician providers supervise diagnostic testing?

Yes. CNM, CNS, NP, and PA would be able to prescribe and bill for services including MCT and EWH.

Will all payors cover the new services?

Currently, all major private insurance carriers are accepting the new CPT codes. Cardiac Monitoring Service is keeping up to date with any changes in accepted CPT codes and allowed amounts.

Will the same increases be seen by clinics billing the CMS Outpatient Prospective Payment System (OPPS) instead of Physician Fee Schedule (PFS)?

The OPPS system is designed to cover the administration labor costs of these tests by in-facility staff, and do not pay for the test itself. OPPS-equivalents to the PFS codes are also proposed for 2021, which do not have substantial differences in payments between 1-2 day and the EWH services.

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