Aetna modified CPB 0073 for cardiac event monitors, effective September 26, 2025. Here's what billing teams need to know before claims start hitting the new criteria.
Aetna, a CVS Health company, updated its cardiac event monitor coverage policy under CPB 0073 in the Aetna Clinical Policy Bulletins system. This modification affects 31 CPT codes and two HCPCS codes — including remote monitoring codes like 93228 and 93229, subcutaneous loop recorder codes 33285 and 33286, and the newer extended Holter series from 93241 through 93248. If your practice bills for cardiac monitoring across cardiology, neurology, or electrophysiology, this policy change touches your revenue directly.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Cardiac Event Monitors — CPB 0073 |
| Policy Code | CPB 0073 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Cardiology, Electrophysiology, Neurology, Primary Care, Internal Medicine |
| Key Action | Audit your cardiac monitoring charge capture against updated selection criteria before billing under any of the 31 affected CPT codes |
Aetna Cardiac Event Monitor Coverage Criteria and Medical Necessity Requirements 2025
The Aetna cardiac event monitor coverage policy under CPB 0073 covers several categories of cardiac monitoring — but only when selection criteria are met. That phrase, "when selection criteria are met," is the load-bearing language in this policy. Coverage is not automatic based on diagnosis code alone.
Aetna considers external and implantable cardiac event monitors medically necessary for documented arrhythmia evaluation, post-stroke and TIA workup, and unexplained syncope or palpitations. The ICD-10 landscape here is broad — the policy covers everything from paroxysmal tachycardia (I47.0–I49.9) and atrial fibrillation to cerebral infarction (I63.0–I63.9) and transient ischemic attacks (G45.0–G45.9). R-code diagnoses like R55 (syncope and collapse), R00.2 (palpitations), R42 (dizziness), and R56.9 (unspecified convulsions) are also listed, which matters for practices that bill these as primary diagnoses in outpatient settings.
For external monitoring, the covered CPT codes break into three duration tiers. The 93241–93244 series covers recordings from more than 48 hours up to seven days. The 93245–93248 series covers more than seven days up to 15 days. The newest codes in this policy — 0937T through 0940T — cover recordings greater than 15 days up to 30 days. That 30-day extended monitoring tier is where you need to pay closest attention, because reimbursement depends on billing each component code in the right sequence.
External mobile cardiovascular telemetry (MCT) falls under 93228 and 93229. These codes cover concurrent computerized rhythm analysis with attended surveillance. They are covered when selection criteria are met, not as a blanket benefit — which means your documentation has to establish why MCT was chosen over a shorter-duration Holter alternative.
For implantable loop recorders, Aetna covers insertion (CPT 33285) and removal (CPT 33286), along with HCPCS C1764 and E0616 for the device itself. Programming evaluations fall under CPT 93285 (in-person) and 0650T (remote). Interrogation codes 93291 (in-person) and 93298 (remote, up to 30 days) round out the implantable monitoring code set.
Prior authorization requirements are not explicitly detailed in the policy summary for every code, but given Aetna's track record on cardiac monitoring — and the addition of newer Category III codes — you should confirm prior auth requirements with Aetna directly for 0937T–0940T before your first claim goes out. If you're not sure which monitoring services in your mix require prior authorization, talk to your billing consultant before September 26, 2025.
Aetna Cardiac Event Monitor Exclusions and Non-Covered Indications
Six CPT codes are explicitly listed as not covered for the indications described in CPB 0073. These aren't edge cases — they're codes your team may have attempted to bill before, especially if you've been watching the algorithmic ECG space.
CPT 0497T and 0498T cover external patient-activated, physician-prescribed electrocardiographic rhythm-derived event monitoring. Aetna is not covering these for the indications listed in CPB 0073.
CPT 0902T covers QTc interval analysis using augmentative algorithms from an external patient-activated device. Also not covered.
CPT 0903T, 0904T, and 0905T cover algorithmically generated 12-lead ECGs from reduced-lead input — with interpretation, tracing only, and interpretation/report, respectively. All three are excluded.
CPT 93040 — the basic rhythm ECG with one to three leads and interpretation — is also not covered under this policy for the listed indications.
The real issue with this exclusion list is that several of these codes represent newer technology that practices have been billing with mixed results. If you've been submitting 0902T or 0903T for Aetna patients, expect claim denial under CPB 0073. Pull any open claims before September 26, 2025.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Arrhythmia evaluation (paroxysmal tachycardia, AFib, flutter, other) | Covered | I47.0–I49.9; CPT 93228, 93229, 93241–93248, 93268–93272 | Selection criteria must be met |
| Unexplained syncope or collapse | Covered | R55; CPT 93241–93248, 33285, 33286 | Selection criteria must be met |
| Palpitations | Covered | R00.2; CPT 93268–93272, 93241–93248 | Selection criteria must be met |
| Dizziness or lightheadedness | Covered | R42; CPT 93241–93248 | Selection criteria must be met |
| Unspecified convulsions / seizures NOS | Covered | R56.9; CPT 93241–93248, 33285, 33286 | Selection criteria must be met |
| Tachycardia, unspecified | Covered | R00.0; CPT 93228, 93229, 93241–93248 | Selection criteria must be met |
| Bradycardia, unspecified | Covered | R00.1; CPT 93241–93248, 33285, 33286 | Selection criteria must be met |
| TIA and related syndromes | Covered | G45.0–G45.9; CPT 33285, 33286, 93298, 93285 | Selection criteria must be met |
| Cerebral infarction (ischemic stroke) | Covered | I63.0–I63.9; CPT 33285, 33286, 93298 | Selection criteria must be met |
| History of TIA or cerebral infarction without residual deficit | Covered | Z86.73; CPT 33285, 33286, 93298 | Selection criteria must be met |
| AV block and bundle-branch block | Covered | I44.0–I45.9; CPT 93241–93248, 33285, 33286 | Selection criteria must be met |
| 30-day extended external recording | Covered | CPT 0937T, 0938T, 0939T, 0940T | Newest codes in this policy; confirm prior auth |
| Algorithmic 12-lead ECG from reduced lead | Not Covered | CPT 0902T, 0903T, 0904T, 0905T | Excluded for CPB 0073 indications |
| Patient-activated external event monitoring (algorithmic) | Not Covered | CPT 0497T, 0498T | Excluded for CPB 0073 indications |
| Basic rhythm ECG (1–3 leads) | Not Covered | CPT 93040 | Excluded for CPB 0073 indications |
Aetna Cardiac Event Monitor Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for 0937T–0940T before September 26, 2025. These extended 30-day recording codes are new to the covered list. If your system hasn't been built to trigger them for appropriate patients, you're leaving reimbursement on the table. |
| 2 | Remove 0497T, 0498T, 0902T, 0903T, 0904T, 0905T, and 93040 from any Aetna cardiac monitoring order sets. These are now explicitly not covered under CPB 0073. Any claims going out after the effective date will deny. Pull any claims pending adjudication that include these codes for Aetna members. |
| 3 | Verify your duration-tiered Holter coding is mapped correctly. The 93241–93244 series (48 hours to seven days), 93245–93248 series (seven to 15 days), and 0937T–0940T series (15 to 30 days) each have component codes for recording, scanning, and interpretation. Bill the wrong tier for the actual recording duration and you're looking at a claim denial or audit exposure. |
| 4 | Confirm prior authorization requirements for implantable loop recorder insertion (CPT 33285) and the new 30-day monitoring codes (0937T–0940T) with Aetna's provider services line. The policy does not spell out prior auth requirements explicitly, but Aetna routinely requires it for implantable cardiac monitoring and newer Category III codes. Don't assume a clean claim path without checking. |
| 5 | Update your ICD-10 pairing logic for cardiac monitoring orders. The covered diagnosis codes span neurology (G45.x, I63.x), cardiology (I44.x–I49.x), and symptom-level codes (R00.0, R00.1, R00.2, R42, R55, R56.9). Make sure your cardiac event monitoring billing guidelines map the right ICD-10 codes to the right monitoring type — a Z86.73 (history of TIA) paired with a 30-day implantable loop recorder is very different clinically from R00.2 (palpitations) paired with a seven-day Holter. |
| 6 | Document medical necessity explicitly in the ordering note. "Selection criteria are met" is Aetna's language — and it means your clinical documentation has to show why continuous monitoring was chosen, for what duration, and what prior workup was completed. Vague "rule out arrhythmia" notes won't hold up on audit or appeal. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Cardiac Event Monitors Under CPB 0073
Covered CPT Codes (When Selection Criteria Are Met)
| Code | Description |
|---|---|
| 0650T | Programming device evaluation (remote) of subcutaneous cardiac rhythm monitor system, with iterative adjustment |
| 0937T | External electrocardiographic recording >15 days up to 30 days by continuous rhythm recording — complete service |
| 0938T | External electrocardiographic recording >15 days up to 30 days — recording (includes connection and initial recording) |
| 0939T | External electrocardiographic recording >15 days up to 30 days — scanning analysis with report |
| 0940T | External electrocardiographic recording >15 days up to 30 days — review and interpretation by physician or QHCP |
| 33285 | Insertion, subcutaneous cardiac rhythm monitor, including programming |
| 33286 | Removal, subcutaneous cardiac rhythm monitor |
| 93228 | External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized rhythm monitoring |
| 93229 | External MCT — technical support for connection and patient instructions, attended surveillance, analysis and report |
| 93241 | External electrocardiographic recording >48 hours up to 7 days — complete service |
| 93242 | External electrocardiographic recording >48 hours up to 7 days — recording only |
| 93243 | External electrocardiographic recording >48 hours up to 7 days — scanning analysis with report |
| 93244 | External electrocardiographic recording >48 hours up to 7 days — review and interpretation |
| 93245 | External electrocardiographic recording >7 days up to 15 days — complete service |
| 93246 | External electrocardiographic recording >7 days up to 15 days — recording only |
| 93247 | External electrocardiographic recording >7 days up to 15 days — scanning analysis with report |
| 93248 | External electrocardiographic recording >7 days up to 15 days — review and interpretation |
| 93268 | External patient and auto-activated electrocardiographic rhythm-derived event recording — complete service |
| 93270 | External cardiac event recording — recording (includes connection, recording, and disconnection) |
| 93271 | External cardiac event recording — transmission and analysis |
| 93272 | External cardiac event recording — review and interpretation by physician or QHCP |
| 93285 | Programming device evaluation (in person) with iterative adjustment of implantable device |
| 93291 | Interrogation device evaluation (in person) with analysis, review, and report |
| 93298 | Interrogation device evaluation (remote) up to 30 days — implantable loop recorder system |
Covered HCPCS Codes (When Selection Criteria Are Met)
| Code | Description |
|---|---|
| C1764 | Event recorder, cardiac (implantable) |
| E0616 | Implantable cardiac event recorder with memory, activator, and programmer |
Not Covered CPT Codes
| Code | Description | Reason |
|---|---|---|
| 0497T | External patient-activated, physician-prescribed electrocardiographic rhythm-derived event monitoring | Not covered for CPB 0073 indications |
| 0498T | External patient-activated, physician-prescribed electrocardiographic rhythm-derived event monitoring (technical component) | Not covered for CPB 0073 indications |
| 0902T | New QTc interval derived by augmentative algorithmic analysis of input from external patient-activated device | Not covered for CPB 0073 indications |
| 0903T | Algorithmically generated 12-lead ECG from reduced-lead ECG — with interpretation and report | Not covered for CPB 0073 indications |
| 0904T | Algorithmically generated 12-lead ECG from reduced-lead ECG — tracing only | Not covered for CPB 0073 indications |
| 0905T | Algorithmically generated 12-lead ECG from reduced-lead ECG — interpretation and report only | Not covered for CPB 0073 indications |
| 93040 | Rhythm ECG, one to three leads, with interpretation and report | Not covered for CPB 0073 indications |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| G45.0 | Vertebro-basilar artery syndrome |
| G45.1 | Carotid artery syndrome (hemispheric) |
| G45.2 | Multiple and bilateral precerebral artery syndromes |
| G45.3 | Amaurosis fugax |
| G45.8 | Other transient cerebral ischemic attacks and related syndromes |
| G45.9 | Transient cerebral ischemic attack, unspecified |
| I44.0–I45.9 | Atrioventricular and left bundle-branch block and other conduction disorders |
| I47.0–I49.9 | Paroxysmal tachycardia, atrial fibrillation and flutter, and other cardiac arrhythmias |
| I63.0–I63.9 | Cerebral infarction (multiple subcategories) |
| I63.00–I66.9 | Cerebral infarction; occlusion and stenosis of precerebral and cerebral arteries |
| R00.0 | Tachycardia, unspecified |
| R00.1 | Bradycardia, unspecified |
| R00.2 | Palpitations |
| R42 | Dizziness and giddiness |
| R55 | Syncope and collapse |
| R56.9 | Unspecified convulsions |
| Z86.73 | Personal history of TIA and cerebral infarction without residual deficits |
Get the Full Picture for CPT 33285
Track this policy across versions, search 1,500+ policies by CPT code, and get real-time alerts when any payer changes coverage.