Clinical review requirements for long-term continuous ECG rhythm recording and storage services

For BCN Advantage^SM members. For BCN Advantage members, neither referral nor clinical review is required for services involving long-term continuous electrocardiographic rhythm recording and storage devices worn on an adhesive patch when supplied by a contracted provider and used for time periods longer than 48 hours, up to 14 days. This applies to devices such as the Zio^® Patch and LifeStar ACT and to procedure codes *0295T through *0298T.

Clinical review is required for all providers not contracted with BCN. This includes the manufacturers of the ECG monitoring devices. If the manufacturer will be billing BCN directly for procedure code *0297T, clinical review is required.

For BCN HMO^SM members. For BCN HMO (commercial) members, clinical review is still required for continuous ECG monitoring using these rhythm recording and storage devices. You can submit your request for review via the e-referral system or by calling BCN Care Management at 1-800-392-2512. For commercial members, the following two clinical review requests need to be entered:

• One request for codes *0295T, *0296T or *0298T to be submitted by the specialist or facility (or both), to hook up the device and interpret the results
• One request for code *0297T to be submitted by the provider of the device, for the device itself

Date span on the request. The date span on requests for all members should be 45 days, to allow time for the various activities associated with these devices, including device hook-up, member instruction, the days the device is actually in use, the return of the device and interpretation of the results.

* CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.