CPT 93226Cardiology

Xtrnl ecg rec<48 hr scan a/r

CPT code 93226 covers the analysis and report of a continuous heart rhythm recording taken outside the hospital for up to 48 hours using a portable monitor. The physician reviews the recording data and prepares a formal interpretation after the monitoring period is complete.

Showing rates for

National Average

Base Medicare rate

$33.32

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

PE RVU (NF)

1.02

MP RVU

0.01

Total RVU

1.03

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

NCCI bundling edits

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Billing tips

Ensure proper sequencing with hookup (93224) and recording (93225) codes - 93226 is the analysis component only
Impact: Prevents $33-66 in lost revenue from unbundling denials; all three components typically needed for complete service
Document exact duration of recording analyzed (must be up to 48 hours) and specify if full period or partial period was interpretable
Impact: Recording periods >48 hours require different code (93227/93228); using wrong code causes 100% denial
Include scanning methodology and technology platform in documentation to distinguish from attended monitoring services
Impact: Differentiates from real-time monitoring codes that pay differently; prevents medical necessity denials
Bill on the date the interpretation and report are completed and signed, not the date monitoring began
Impact: Aligns with Medicare date-of-service rules; incorrect dating causes processing delays averaging 15-30 days
Verify patient has not received another external ECG analysis within the same monitoring period to avoid duplicate billing
Impact: Prevents compliance risk and 100% denial for duplicate service; some audits assess post-payment lookback
When billing with E/M services on same date, ensure medical necessity for both is clearly documented as separate and distinct
Impact: Without modifier 25 on E/M and clear documentation, E/M may be bundled resulting in $75-150 loss per encounter

Common denials

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Frequently asked questions

What is CPT code 93226 used for?

CPT 93226 is used to bill for the physician's analysis and interpretation of an external electrocardiographic (ECG) recording that lasted up to 48 hours. This code covers only the scanning and report component, not the equipment hookup or the recording itself, which are billed separately.

How much does Medicare pay for CPT 93226 in 2025?

Medicare pays $33.32 for CPT 93226 in 2025 based on the national average non-facility rate. The code has 1.03 total RVUs (0 work RVU, 1.02 practice expense RVU, 0.01 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 93226 be billed with 93224 and 93225?

Yes, CPT 93226 is typically billed together with 93224 (hookup and initial recording) and 93225 (recording component) as they represent different components of the complete external ECG monitoring service up to 48 hours. These codes are designed to be used together and are not bundled by NCCI edits when properly documented.

What is the difference between CPT 93226 and 93228?

CPT 93226 is for scanning analysis of external ECG recordings up to 48 hours, while CPT 93228 is for recordings greater than 48 hours up to 21 days. The duration of the monitoring period determines which analysis code to use; using the wrong code based on recording length will result in denial.

What documentation is required for CPT 93226?

Documentation must include a complete signed physician interpretation report with analysis of the full recording period, quantification of arrhythmias, symptom correlation with ECG findings, diagnostic impression, and clear indication that the recording duration was up to 48 hours. The report date determines the date of service for billing.

Does CPT 93226 require a modifier 26?

Modifier 26 is only required when billing the professional component separately because a different entity owns the equipment and provides the technical component. If your practice provides both the equipment and interpretation, bill 93226 without a modifier for the global service.

How often can CPT 93226 be billed for the same patient?

CPT 93226 can be billed once per monitoring period. Frequency limitations vary by payor, but Medicare typically allows external cardiac monitoring when medically necessary based on symptoms or clinical changes. Repeated monitoring within short timeframes requires strong documentation of new or changed symptoms to establish medical necessity.