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Anthem Blue Cross ConnecticutCommercial Clinical Policy

Anthem Blue Cross Connecticut CG-MED-62 Resting Electrocardiogram Screening in Adults Form


Resting Electrocardiogram Screening in Adults

Indications

(119648) Does the patient have any known signs or symptoms of heart disease? 
(119649) Is there a family history of sudden cardiac death for the patient? 
(119650) Is the patient at high risk for coronary heart disease event, defined as a 10-year risk 10% or greater? 

Contraindications

(119651) Are both no known signs or symptoms of heart disease and no family history of sudden cardiac death present in the patient? 
(119652) Is the individual considered to be at low risk for a coronary heart disease event, where low risk is defined as a 10-year risk less than 10%? 
Effective Date

09/27/2023

Last Reviewed

08/10/2023

Original Document

  Reference



This document addresses the performance of resting electrocardiogram (ECG, EKG) in the screening of asymptomatic adults with no known heart disease. This document does not address the use of ECG for preoperative screening.

Note: Please see the following related document for additional information:

  • CG-MED-61 Preoperative Testing for Low Risk Invasive Procedures and Surgeries

Clinical Indications

Not Medically Necessary:

Resting electrocardiogram testing in adults (greater than or equal to 18 years of age) is considered not medically necessary, when both of the following are present:

  1. There are no known signs or symptoms of heart disease and there is no family history of sudden cardiac death; and
  2. The individual is at low risk for coronary heart disease event, where low risk is defined as a 10-year risk less than 10%.