Does A9279 require prior authorization?

Yes, A9279 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for A9279?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A9279`, Monitoring feature/device, stand-alone or integrated, any type, includes all

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

None specified in the policy (no documentation requirements listed because the devices are designated experimental/investigational and not covered).
For ILR in recurrent or unexplained syncope: documentation that non-arrhythmic causes have been excluded by appropriate testing (e.g., reflex syncope, orthostatic hypotension, volume depletion, dehydration, blood loss).

For ILR in recurrent or unexplained syncope and for cryptogenic stroke/TIA: documentation that noninvasive ambulatory cardiac monitoring for a minimum of 14 days was performed and was inconclusive or non-diagnostic (e.g., patch monitors, external event monitors).

For replacement of an implantable electrocardiographic event monitor: documentation that the individual continues to meet ALL ILR criteria and that the existing monitor is no longer under warranty and cannot be repaired (e.g., device nearing end of battery life).

Key Coverage Criteria

None — Aetna considers cholesterol monitors for home use (e.g., Cholestron cholesterol monitor, molecularly imprinted membrane modified gel colorimetric device) experimental and investigational and does not identify any covered indications in this policy.
Ambulatory external cardiac monitoring from 48 hours to 30 days (Current Procedural Terminology [CPT®] codes 93241-93248, 93268, 93270-93272, 0937T-0940T) is considered medically necessary when ANY of the following criteria are met:
symptoms of presyncope, syncope, or severe palpitations when there is clinical suspicion of a significant bradyarrhythmia or tachyarrhythmia
evaluation of atrial fibrillation for rhythm and/or rate control when the results will directly impact clinical decision-making (pre- and/or post-ablation)
following stroke or transient ischemic attack (TIA) of undetermined cause (CPT® 93268, 93270-93272)
following cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFL) if individual is not receiving ongoing anticoagulation and deemed to be at high thromboembolic risk (e.g., CHA2DS2-VASc score ≥ 2)

5 Active Policies

CIGNA-0547, Ambulatory External and Implantable Electrocardiographic Monitoring

ANTHEM-CG-DME-42, Continuous Glucose Monitoring Devices

ANTHEM-MED.00133, Ingestion Event Monitors

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

AETNA-CPB-0367, Home Cholesterol Monitors

`A9279`, Monitoring feature/device, stand-alone or integrated, any type, includes all

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

A9279, Monitoring feature/device, stand-alone or integrated, any type, includes all

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

`A9279`, Monitoring feature/device, stand-alone or integrated, any type, includes all