Remote heart monitoring has fundamentally changed how cardiac care is delivered. However, at the same time, billing these remote services is quite challenging and requires deep knowledge of the billing codes and guidelines.
One such code is CPT code 93294. That’s why our billing experts at NeuraBill have created this detailed guide on 93294 and how to use it effectively in billing. So, let’s start.
CPT Code 93294 – Description
CPT code 93294 is defined as:
“Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, or leadless pacemaker system with interim analysis, review(s), and report(s) by a physician or other qualified healthcare professional.”
Let’s simplify this. 93294 is a cardiology billing code. It represents the services of a physician or a qualified healthcare professional in reviewing the data transmitted by a pacemaker that is implanted in a patient’s heart. By analyzing the data, the physician evaluates the heart rhythm and the device function and creates a professional report for comprehensive record-keeping.
What’s important to note here is that CPT code 93294 is part of a two-code set. CPT codes 93296 and 93294 represent different parts of the same service. 93294 is used to bill the professional component of the pacemaker evaluation, while 93296 represents the technical component of the service.
Additionally, CPT 93294 applies to both traditional single, dual, or multiple lead pacemaker systems and newer leadless pacemaker systems. Furthermore, it is also the appropriate code for the remote professional evaluation of Cardiac Resynchronization Therapy (CRT) pacemakers.
93294 can be used for remote monitoring up to 30-90 days. If the monitoring period is less than 30 days, do not use this code. Note that the physician remotely evaluates the data the device sends over the monitoring period. Physical contact or on-site evaluations are not required for this code to be valid.
Appropriate Use Cases for CPT Code 93294
Let’s clarify things further with a couple of real-world scenarios in which CPT code 93294 can be used.
Atrioventricular Block
Suppose an elderly patient with complete atrioventricular block had a permanent pacemaker implanted six months ago due to severe heart block, causing syncopal episodes (fainting). To ensure proper pacing function and capture, the physician performs a remote interrogation evaluation. The remote assessment includes reviewing the device’s pacing parameters, percentage of ventricular pacing, and battery longevity over the past 90 days.
In this scenario, the physician can use CPT code 93294 to bill his evaluation services.
Longstanding Persistent Atrial Fibrillation
Suppose that a patient with longstanding persistent atrial fibrillation had a dual-chamber pacemaker implanted in his heart two years ago to manage irregular heart rhythm. He reports occasional palpitations and fatigue despite medication.
To monitor the device’s performance and assess the atrial fibrillation, the physician performs a remote interrogation of the pacemaker system. The remote evaluation analyzes 90 days of stored cardiac data, battery status, and lead impedance.
After that, the medical billing department codes and submits the claim for reimbursement. In this case, the billing department can use CPT code 93294 to bill the professional component of the service.
Reimbursement Guidelines for CPT Code 93294
The following are some billing and reimbursement guidelines that you should follow to improve your claim acceptance rate.
Append Comprehensive Documentation
For a claim to be valid, documentation must be impeccable. The patient’s medical record must include:
- A signed and dated report by the physician.
- Details of the findings (battery status, lead impedance, sensing/capture thresholds).
- Any clinical actions taken (e.g., “continue current programming” or “schedule in-office visit for adjustment”).
- Confirmation that the data was reviewed remotely.
- Physician report.
Keep in Mind the Frequency Limitations
The billing frequency is strictly regulated. CPT 93294 can be billed a maximum of 4 times per year, corresponding to the 90-day monitoring periods. If you bill it more than once in the 90-day period, your claims will be denied.
Additionally, the code can be used for monitoring between 30 and 90 days. If the monitoring period is less than 30 days, do not use CPT code 93294.
Verify Medicare Reimbursement Rate
According to the 2026 Physician Fee Schedule (PFS), Medicare currently pays $29.39 for CPT code 93294 in both facility and non-facility settings.
However, this rate varies significantly for each Medicare Administrative Contractor (MAC) locality. You can check the exact rate for your MAC via the PFS Lookup Tool.
Final Thoughts on CPT Code 93294
Let’s wrap up everything we have discussed. CPT code 93294 is a popular cardiology billing code and represents the professional component of remote interrogation pacemaker evaluation. In most cases, the code does not require any modifiers and can be used standalone. However, for proper reimbursement, you must provide detailed documentation with your claims.
Medical billing and coding are complex processes that require expertise. Consider contacting our expert billing consultants if you are facing frequent billing errors and claim denials. We offer premium cardiology billing services that can boost your revenue.
