Heart diseases are among the most prevalent medical issues in the country. Every year, over 805,000 people have a heart attack in the United States. Oftentimes, cardiac devices like pacemakers are implanted in patients to help them with their recovery. However, these devices require continuous maintenance and data extraction.
One code that accurately reports the remote monitoring of such implantable cardiac devices is CPT code 93296. We have created this guide to help you understand what this code represents and how you can bill it properly.
So, let’s start.
CPT Code 93296 – Description
CPT code 93296 is defined as:
“Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results”.
That’s quite a long definition, so let’s simplify it in easy terms.
93296 represents the remote monitoring and evaluation process for patients with pacemakers or implantable defibrillators. The whole service is based on two core parts:
- Collecting data from the device for up to 90 days and transmitting it remotely.
- Having a technician review the data to ensure the device is functioning as expected.
Technician review includes the analysis of transmitted data by qualified cardiovascular technicians who evaluate device performance, battery status, lead integrity, and arrhythmic events.
An important point to note here is that code 93296 can be used for remote monitoring of 30 to 90 days. If the monitoring period is less than 30 days, do not use this code.
Appropriate Use Cases for CPT Code 93296
Let’s clarify things further with a couple of real-world scenarios in which CPT code 93296 can be used:
Right Fascicular Block
For our first scenario, suppose a 60-year-old woman comes to a cardiology practice. She shares with the physician that she often feels dizzy and fatigued and experiences fainting (syncope) and shortness of breath. She has been feeling this way for over six months. She also shares that she visited a general physician who prescribed some multivitamins and other medications. However, those didn’t help. To diagnose the condition, the cardiologist performs an electrocardiogram (ECG), which reveals a right fascicular block. This means that the electrical conduction in the heart’s right bundle branch is delayed or disrupted.
The cardiologist suspects the patient might benefit from an implantable device to track cardiac rhythm patterns and detect any progression. So, he orders an implantable loop recorder that the patient already has in place for arrhythmia surveillance. However, the technician needs to ensure that the device is functioning correctly. So, he remotely collects data from the device for 90 days. This data is reviewed by the technician, and the results indicate it is working correctly.
In this case, the data recording, transmission, technical review, and report creation can be billed via CPT code 93296.
Cardiac Arrest
Suppose a 58-year-old patient is recovering from a sudden cardiac arrest of unknown origin. After resuscitation and stabilization, the cardiologist implants a cardioverter-defibrillator (ICD) to prevent future life-threatening arrhythmias. During a follow-up visit, the physician programs the ICD to optimize detection parameters and therapy settings specific to the patient’s cardiac condition. The device is configured to monitor heart rhythms continuously and deliver appropriate interventions if needed. All this data is collected and monitored for 90 days.
A technician reviews this data and creates a report showing that the device is working properly. At the end, the medical billing department codes and submits the claim for reimbursement. In this case, CPT code 93296 is used for the remote monitoring of the implantable cardiac device.
Reimbursement Guidelines for CPT Code 93296
Denials can happen due to a small error. To avoid them and increase your chances of claim acceptance, pay attention to the following points:
Provide Detailed Documentation
Documentation is key for all medical insurance claims. You must justify the medical necessity of the procedure with detailed documentation. For CPT code 93296, the following details are recommended:
- Precise dates of monitoring with clear identification of the 90-day monitoring period.
- Detailed device type specifications, including manufacturer, model, and lead configuration.
- Summary of technical analysis findings, including battery status, lead impedances, and arrhythmic events.
- Written confirmation that the analyzed data and technical findings were transmitted to the supervising physician.
Meet the Medical Necessity Criteria
Proving the medical necessity of CPT code 93296 is vital for reimbursement. You must justify the use of this code with a valid ICD-10 code. The following are some of the diagnosis codes that support 93296:
- I44.1: Atrioventricular block, second degree
- I44.2: Atrioventricular block, complete
- I44.4: Left anterior fascicular block
- I44.5: Left posterior fascicular block
- I44.60: Unspecified fascicular block
- I44.69: Other fascicular block
- I44.7: Left bundle-branch block, unspecified
- I45.0: Right fascicular block
You can find the complete list of approved ICD-10 codes in CMS’s guide on Cardiac Rhythm Device Evaluation.
Verify Medicare Reimbursement Rate
According to the 2025 Physician Fee Schedule, Medicare currently pays $19.41 for CPT code 93296 in non-facility settings.
However, this rate varies significantly for each Medicare Administrative Contractor (MAC) locality. You can check the exact amount for your MAC via the PFS Lookup Tool.
Final Thoughts on CPT Code 93296
In this guide, we have covered a lot of ground on CPT code 93296, which can be hard to remember. So, let’s do a quick recap of the most essential points.
93296 represents the remote monitoring/evaluation of a cardiac device for up to 90 days. Also, the code only represents the technical part of the procedure, such as data gathering, technical review, and data reporting. For fair and proper reimbursement, you must submit detailed documentation with your claims.
You can save this guide for future reference. However, if you are having difficulty filing your cardiac claims, you can consider NeuraBill’s specialized cardiology billing services.
