CPT 93152Cardiology

Interrog&prgrmg ipnss polysm

CPT 93152 covers the interrogation and programming of an implantable pacemaker system with dual-chamber or multiple-lead capability. This involves checking how the device is functioning and adjusting its settings to optimize heart rhythm management.

Showing rates for

National Average

Base Medicare rate

$136.50

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.82

PE RVU (NF)

2.27

MP RVU

0.13

Total RVU

4.22

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Verify place of service (POS) code accuracy: POS 11 (office) triggers non-facility rate of $136.50 while POS 22 (hospital outpatient) triggers facility rate of $84.42
Impact: $52.08 difference between non-facility and facility rates makes POS coding critical for maximum reimbursement
Document all programming changes made during the session, including specific parameter adjustments (AV delay, pacing mode, rate response settings, lead outputs)
Impact: Detailed programming documentation reduces denial risk by 60-70% and supports medical necessity for more frequent visits
Do not bill 93152 on the same date as remote interrogation codes (93294-93296) unless distinct sessions with modifier 59
Impact: Prevents automatic bundling denials; improper billing can result in 100% claim rejection and audit flags
Separate E/M services with modifier 25 only when addressing clinical issues beyond routine device management
Impact: Properly documented E/M with 25 can add $75-$200 to encounter value, but improper use triggers audit risk
Bill 93152 for dual-chamber devices only; single-chamber devices use 93279 or 93280 instead
Impact: Using wrong code based on device type results in immediate denial or downcoding with $40-$60 payment reduction
Ensure interrogation occurs within appropriate follow-up intervals per Medicare guidelines: 3 months for devices nearing ERI, 12 months for newer devices
Impact: Billing outside LCD frequency limits results in denial; establishing medical necessity for off-schedule checks can recover $136.50 per visit

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Frequently asked questions

What is the difference between CPT 93152 and 93279?

CPT 93152 is for in-person interrogation and programming of dual-chamber or multi-lead pacemaker systems, while 93279 is specifically for single-chamber pacemaker systems. The device type determines which code to use, with 93152 having a higher reimbursement ($136.50 vs approximately $85-90 for single-chamber codes) due to increased complexity.

How often can I bill CPT 93152 for the same patient?

Medicare LCD guidelines typically allow in-person device interrogation every 12 months for newer devices and every 3 months for devices approaching elective replacement indicator (ERI). More frequent billing is permitted with documented medical necessity such as new symptoms, arrhythmias, medication changes, or device alerts requiring evaluation.

Can I bill an E/M code with 93152 on the same day?

Yes, you can bill a separate E/M service with modifier 25 when the evaluation addresses clinical issues distinct from the routine device interrogation. The E/M must involve evaluation of symptoms, comorbidities, or conditions beyond device function, with documentation clearly showing separate work performed.

What is the 2025 Medicare reimbursement for CPT 93152?

The 2025 Medicare national average reimbursement is $136.50 for non-facility settings (physician office) and $84.42 for facility settings (hospital outpatient department). Actual payment may vary based on geographic location and MAC-specific adjustments.

Does CPT 93152 include both interrogation and programming?

Yes, CPT 93152 is a comprehensive code that includes both device interrogation (downloading and reviewing stored data) and programming (adjusting device parameters). You should not separately bill for interrogation-only services when programming is performed; 93152 covers the complete service.

Can I bill 93152 for a biventricular pacemaker (CRT-P)?

No, biventricular pacemakers (CRT-P devices) require different codes. Use 93283 for in-person interrogation and programming of cardiac resynchronization therapy pacemakers. Using 93152 for CRT-P devices will result in claim denial or incorrect payment.

What is the difference between 93152 and remote monitoring codes 93294-93296?

CPT 93152 is for in-person, face-to-face device interrogation with real-time physician interaction and programming capability. Remote monitoring codes (93294-93296) are for automated data transmissions reviewed without patient present. These are distinct services with different frequency limitations and cannot typically be billed on the same date without modifier 59 and supporting documentation.