CG-MED-62 Resting Electrocardiogram Screening in Adults

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.

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:

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When services are Not Medically Necessary:
When the code describes a procedure designated in the Clinical Indications section as not medically necessary.

Resting ECG is a noninvasive test used to detect and record the hearts electrical activity, rate, and regularity of heart as well as the strength and timing of the electrical impulses passing through each part of the heart. Resting ECG screening may be used to further evaluate symptoms related to heart disease.

According to the Centers for Disease Control and Prevention coronary heart disease (CHD), also known as coronary artery disease (CAD), is the most common heart disease reported, with an associated annual mortality of over 375,000 individuals in the U.S. in 2021. Smoking, high blood pressure, and high cholesterol are key risk factors for heart disease. Other medical conditions and lifestyle choices contribute to heart disease including diabetes, obesity, poor diet, physical inactivity and alcohol abuse (CDC, 2024).

In 2010, the American College of Cardiology Foundation and the American Heart Association (ACC/AHA) guideline for assessment of cardiovascular risk in asymptomatic adults issued a category IIb recommendation, indicating a “weak benefit > risk” ratio, for use of resting ECG in cardiovascular risk assessment in asymptomatic adults without hypertension or diabetes. (Greenland, 2010).

The American Academy of Family Physicians (AAFP) summary of recommendations for clinical preventive services recommend against use of routine resting ECG in asymptomatic adults at low risk for CHD and found insufficient evidence for adults at increased risk for CHD events (AAFP, 2014).

The U.S. Preventive Services Task Force (USPSTF) recommends against screening with resting or exercise ECG for predication of CHD events in asymptomatic adults at low risk for CHD events. Several risk calculators are available to make a reasonable determination of the 10-year likelihood of a coronary heart disease-related event; one of the best known models is from the Framingham Adult Treatment Panel III (Framingham tool located on the National Institute of Health website, see hyperlink below). Individuals with less than a 10% likelihood of a coronary event in the next 10 years are considered to be at low risk. The USPSTF has rated the current medical evidence insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG for the prediction of CHD events in asymptomatic adults at intermediate or high risk. This recommendation is based on “inadequate evidence that adding ECG to conventional risk factor assessment leads to improved stratification of individuals into high, intermediate, or low-risk groups to guide risk management.” (Moyer, 2012). In 2018, the USPSTF updated the 2012 USPSTF recommendations on screening for CHD; the panel recommends against use of screening with resting or exercise ECG to prevent cardiovascular disease (CVD) events in asymptomatic adults at low risk of CVD events. “The USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG to prevent CVD events in asymptomatic adults at intermediate or high risk of CVD events.” (USPSTF, 2018)

In summary, resting electrocardiogram testing in adults with no known signs or symptoms of heart disease (including, but not limited to coronary heart disease) does not have clinical utility in revising risk or in clinical management.

Coronary heart disease (also called coronary artery disease): A disease characterized by narrowing or blockage of the blood vessels supplying blood to the heart.

Screening: Examination of a group to separate well persons from those who have an undiagnosed pathologic condition or who are at high risk.

Sudden Cardiac Death (SCD), also called sudden death: Death resulting from an abrupt loss of heart function (cardiac arrest).

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Subject: Resting Electrocardiogram Screening in Adults
Guideline #: CG-MED-62	Publish Date: 10/01/2024
Status: Reviewed	Last Review Date: 08/08/2024

CPT
93000	Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
93005	Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report
93010	Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only

HCPCS
G0403	Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
G0404	Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
G0405	Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

ICD-10 Diagnosis
	Including, but not limited to, the following diagnosis:
Z00.00	Encounter for general adult medical examination without abnormal findings

Status	Date	Action
Reviewed	08/08/2024	Medical Policy & Technology Assessment Committee (MPTAC) review. Updated Discussion/General Information, References and Websites sections
Reviewed	08/10/2023	MPTAC review. Updated Discussion/General Information, References and Websites sections.
Reviewed	08/11/2022	MPTAC review. Updated Discussion, References and Websites sections.
Reviewed	08/12/2021	MPTAC review. Updated Discussion, References and Websites sections.
Reviewed	08/13/2020	MPTAC review. Updated Discussion, References and Websites sections. Reformatted Coding section.
Reviewed	08/22/2019	MPTAC review. Updated References section.
Reviewed	09/13/2018	MPTAC review. Updated Discussion and References sections.
New	11/02/2017	MPTAC review. Initial document development.