Subject:
Heart Rate Variability Measurement
Description:
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IMPORTANT NOTE:
The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively “Horizon BCBSNJ”) insures or administers. If the member’s contract benefits differ from the medical policy, the contract prevails. Although a service, supply or procedure may be medically necessary, it may be subject to limitations and/or exclusions under a member’s benefit plan. If a service, supply or procedure is not covered and the member proceeds to obtain the service, supply or procedure, the member may be responsible for the cost. Decisions regarding treatment and treatment plans are the responsibility of the physician. This policy is not intended to direct the course of clinical care a physician provides to a member, and it does not replace a physician’s independent professional clinical judgment or duty to exercise special knowledge and skill in the treatment of Horizon BCBSNJ members. Horizon BCBSNJ is not responsible for, does not provide, and does not hold itself out as a provider of medical care. The physician remains responsible for the quality and type of health care services provided to a Horizon BCBSNJ member.
Horizon BCBSNJ medical policies do not constitute medical advice, authorization, certification, approval, explanation of benefits, offer of coverage, contract or guarantee of payment.
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"Heart rate variability" (HRV) has become the accepted term to describe variations of both instantaneous heart rate and RR intervals. Other terms used include cycle length variability, heart period variability, RR variability, and RR interval tachogram. Although these terms more appropriately emphasize the fact that it is the interval between consecutive beats that is being analyzed rather than the heart rate per se, they have not gained as wide acceptance as HRV.
HRV has been proposed to be a quantitative marker for autonomic activity and thought by some to be a predictor of sudden cardiac death. The apparently easy derivation of this measure has popularized its use. Many commercial devices now provide an automated measurement of HRV.
Policy:
(NOTE: For Medicare Advantage, Medicaid and FIDE-SNP, please refer to the Coverage Sections below for coverage guidance.)
Heart rate variability measurement is considered investigational. It has not been proven to improve health outcomes.
Medicare Coverage:
There is no National Coverage Determination (NCD). In the absence of an NCD, coverage decisions are left to the discretion of Local Medicare Carriers. Novitas Solutions, Inc, the Local Medicare Carrier for jurisdiction JL, has not issued a determination for this service. Therefore, Medicare Advantage Products will follow the Horizon BCBSNJ Medical Policy.
Medicaid Coverage:
For members enrolled in Medicaid and NJ FamilyCare plans, Horizon BCBSNJ applies the above medical policy.
FIDE SNP:
For members enrolled in a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP): (1) to the extent the service is covered under the Medicare portion of the member’s benefit package, the above Medicare Coverage statement applies; and (2) to the extent the service is not covered under the Medicare portion of the member’s benefit package, the above Medicaid Coverage statement applies.
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Horizon BCBSNJ Medical Policy Development Process:
This Horizon BCBSNJ Medical Policy (the “Medical Policy”) has been developed by Horizon BCBSNJ’s Medical Policy Committee (the “Committee”) consistent with generally accepted standards of medical practice, and reflects Horizon BCBSNJ’s view of the subject health care services, supplies or procedures, and in what circumstances they are deemed to be medically necessary or experimental/ investigational in nature. This Medical Policy also considers whether and to what degree the subject health care services, supplies or procedures are clinically appropriate, in terms of type, frequency, extent, site and duration and if they are considered effective for the illnesses, injuries or diseases discussed. Where relevant, this Medical Policy considers whether the subject health care services, supplies or procedures are being requested primarily for the convenience of the covered person or the health care provider. It may also consider whether the services, supplies or procedures are more costly than an alternative service or sequence of services, supplies or procedures that are at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the relevant illness, injury or disease. In reaching its conclusion regarding what it considers to be the generally accepted standards of medical practice, the Committee reviews and considers the following: all credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, physician and health care provider specialty society recommendations, the views of physicians and health care providers practicing in relevant clinical areas (including, but not limited to, the prevailing opinion within the appropriate specialty) and any other relevant factor as determined by applicable State and Federal laws and regulations.
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Index:
Heart Rate Variability Measurement
Cycle Length Variability
Heart Period Variability
HRV
RR Interval Tachogram
RR Variability
References:
1. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology, Heart Rate Variability: Standards of Measurement, Physiological Interpretation, and Clinical Use. Circulation. March 1, 1996;93(5):1043-1065.
2. Ziegler D. Cardiovascular autonomic neuropathy: clinical manifestations and measurement. Diabetes Reviews. 1999;V7 N4:342-357.
3. Korczak D, Zuzewicz K, Pfejfer DL. Evaluation of cardiac autonomic function in insulin dependent diabetic patients using power spectral analysis of heart rate variability. Mon Sci Monit. 1997;3(4):530-535.
4. Maser RE. Autonomic Neuropathy: Patient Care. Diabetes Spectrum. 1998;11(4):224-227.
5. Katz A, Liberty IF, Porath A, et al. A Simple Bedside Test of 1-Minute Heart Rate Variability During Deep Breathing as a Prognostic Index After Myocardial Infarction. Am Heart J. 1999;138(1):32-38.
6. Pope CA, Verrier RL, Lovett EG, et al. Heart Rate Variability Associated With Particulate Air Pollution. Am Heart J. 1999;138(5):890-899.
7. Shusterman V, Aysin B, Weiss R, et al. Dynamics of Low-Frequency R-R Interval Oscillations Preceding Spontaneous Ventricular Tachycardia. Am Heart J. 2000. 139(1):126-133.
8. Nanthakumar K, Paquette M, Newman D, et al. Inappropriate Therapy From Atrial Fibrillation and Sinus Tachycardia in Automated Implantable Cardioverter Defibrillators. Am Heart J. 2000;139(5):797-803.
9. Duru F, Candinas R, Dziekan G, et al. Effect of Exercise Training on Heart Rate Variability in Patients With New-Onset Left Ventricular Dysfunction After Myocardial Infarction. Am Heart J. 2000;140(1):157-161.
10. Nolan J, Batin PD, Andrews R, et al. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Ciculation. 1998 Oct;98(15):1510-1516.
11. Stys A, Stys T. Current clinical applications of heart rate variability. Clin Cardiol. 1998 Oct;21(10):719-724.
12. ECRI. Health Technology Assessment Information Service (HTAIS) Hotline. Heart Rate Variability/ R-R Testing for Cardiovascular Autonomic Neuropathy. Updated 08/09/2004. (last accessed 01/14/09).
13. American College of Cardiology. Position Statement: Heart Rate Variability for Risk Stratification of Life-Threatening Arrhythmias. [Available at: http://www.acc.org/qualityandscience/clinical/position/72526.htm (page last updated 06/26/06) (last accessed 01/07/08)].
14. Huikuri HV, Makikallio T, Airaksinen KE, et al. Measurement of heart rate variability: a clinical tool or a research toy? J Am Coll Cardiol 1999 Dec;34(7):1878-1883.
15. Zaza A, Lombardi F. Autonomic indexes based on the analysis of heart rate variability: a view from the sinus node. Cardiovasc Res 2001 Jun;50(3):434-442.
16. Jensen-Urstad M, Samad BA, Jensen-Urstad K, et al. Risk assessment in patients with acute myocardial infarction treated with thrombolytic therapy. J Intern Med 2001 Jun;249(6):527-537.
17. Tank J, Neuke A, Molle A, et al. Spontaneous baroreflex sensitivity and heart rate variability are not superior to classic autonomic testing in older patients with type 2 diabetes. Am J Med Sci 2001 Jul;322(1):24-30.
18. Gerritsen J, Dekker JM, TenVoorde BJ, et al. Impaired autonomic function is associated with increased mortality, especially in subjects with diabetes, hypertension, or a history of cardiovascular disease: the Hoorn Study. Diabetes Care 2001 Oct;24(10):1793-1798.
19. Huikuri HV, Castellanos A, Myerburg RJ. Sudden Death Due To Cardiac Arrhythmias. N Engl J Med 2001 Nov;345(20):1473-1482.
20. Bailey JJ, Berson AS, Handelsman H, et al. Utility of current risk stratification tests for predicting major arrhythmic events after myocardial infarction. J Am Coll Cardiol 2001 Dec;38(7):1912-1915.
21. La Rovere MT, Pinna GD, Hohnloser SH, et al. Baroreflex Sensitivity and Heart Rate Variability in the Identification of Patients at Risk for Life-Threatening Arrhythmias: Implications for Clinical Trials. Circulation 2001 Apr;103(16):2072-2077.
22. Empire Medicare Services. Local Medical Review Policy #L3118: Autonomic Nervous System Function Testing. Effective date: 07/29/05. [Available at: http://www.empiremedicare.com (last accessed 1/8/07)].
23. La Rovere MT, Pinna GD, Maestri R et al. Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation. 2003 Feb4;107(4):565-70.
24. Janszky I, Ericson M, Mittleman MA et al. Heart rate variability in long-term risk assessment in middle-aged women with coronary heart disease: The Stockholm Female Coronary Risk Study. J Intern Med. 2004 Jan;255(1):13-21.
25. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death. JACC 2008 Sep;52(14):1179-99.
26. UpToDate. Evaluation of heart rate variability. Literature review current through September 2016. Topic last updated October 22, 2015.
27. Munoz ML, van Roon A, Riese H, et al. Validity of (Ultra-) Short Recordings for Heart Rate Variability Measurements. PLoS One. 2015 Sep 28;10(9):e0138921.
28. Goldberger AL, Stein PK. Evaluation of heart rate variability. In: UpToDate, Ganz LI, Downey BC (Eds), UpToDate, Waltham, MA. Accessed on September 8, 2017.)
29. Shvartz VA, Kiselev AR, Karavaev AS, et al. Comparative study of short-term cardiovascular autonomic control in cardiac surgery patients who underwent coronary artery bypass grafting or correction of valvular heart disease. Journal of Cardiovascular and Thoracic Research. 2018;10(1):28-35.
30. Guan L, Collet J-P, Mazowita G, Claydon VE. Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability. Frontiers in Neurology. 2018;9:90.
31. Goldberger AL, Stein PK. Evaluation of heart rate variability. In: UpToDate, Ganz LI, Downey BC (Eds), UpToDate, Waltham, MA. Accessed on July 22, 2020.)
Codes:
(The list of codes is not intended to be all-inclusive and is included below for informational purposes only. Inclusion or exclusion of a procedure, diagnosis, drug or device code(s) does not constitute or imply authorization, certification, approval, offer of coverage or guarantee of payment.)
CPT*
HCPCS
* CPT only copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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Medical policies can be highly technical and are designed for use by the Horizon BCBSNJ professional staff in making coverage determinations. Members referring to this policy should discuss it with their treating physician, and should refer to their specific benefit plan for the terms, conditions, limitations and exclusions of their coverage.
The Horizon BCBSNJ Medical Policy Manual is proprietary. It is to be used only as authorized by Horizon BCBSNJ and its affiliates. The contents of this Medical Policy are not to be copied, reproduced or circulated to other parties without the express written consent of Horizon BCBSNJ. The contents of this Medical Policy may be updated or changed without notice, unless otherwise required by law and/or regulation. However, benefit determinations are made in the context of medical policies existing at the time of the decision and are not subject to later revision as the result of a change in medical policy
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