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

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%.