Ext ecg>7d<15d scan a/r
CPT 93247 covers the analysis and report of an extended heart rhythm monitor worn by a patient for more than 7 days but less than 15 days. This code is used when a physician reviews the complete recording and prepares a detailed report of the heart's electrical activity over this extended period.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Verify the exact duration of monitoring documented in the report matches 93247 parameters (>7 to <15 days). Submit with incorrect duration code costs $234.84 per claim.
Impact: Duration mismatch is the #1 denial reason for this code family. Using 93247 for 6-day monitoring results in 100% payment denial, requiring rebilling with correct code 93227
Document the total hours analyzed and the methodology (full scan vs. patient-activated events) in the interpretation report to distinguish from event monitor codes.
Impact: Explicit documentation of continuous scanning analysis prevents downcoding to event monitor codes (93285-93291) which reimburse differently and may reduce payment
Bill 93247 only once per monitoring period regardless of how many interim reports were generated. This is a global interpretation code.
Impact: Multiple billings for the same monitoring session will result in duplicate claim denials. Only the first claim processes; subsequent claims denied saving $234.84 per erroneous submission
Ensure ordering physician documentation clearly indicates medical necessity for extended monitoring beyond standard 24-48 hour Holter (why shorter monitoring was insufficient).
Impact: Medical necessity denials force downcoding to shorter-duration Holter codes or full denial. Strong pre-service documentation reduces denial rate by approximately 40%
Verify patient returned device and complete data set was received before performing analysis. Partial data may require modifier 52 and reduced payment.
Impact: Billing full service for incomplete monitoring invites audits and recoupment. Proactive use of modifier 52 when appropriate maintains compliance and reduces audit exposure
Check payer-specific policies on global periods and whether hookup/scanning/report are separately billable or bundled with 93247.
Impact: Some payers bundle hookup codes (93260) with interpretation codes while others allow separate billing, potentially affecting total reimbursement by $50-100 per encounter
Common denials
Monitoring duration documented in report does not match code descriptor (e.g., only 6 days monitored or 16 days monitored)
How to appeal: Submit corrected claim with appropriate duration-specific code (93227 for 48hr-7days, 93248 for >15 days) along with cover letter explaining coding error. Include monitoring start/stop dates from device report. If dates truly support 93247, submit highlighted device report showing exact monitoring period with notation of inclusive day counting methodology.
Medical necessity not established - payer requires documentation of why extended monitoring beyond standard Holter was clinically necessary
How to appeal: Submit appeal with ordering physician notes documenting: (1) previous negative shorter-duration monitoring results, (2) infrequent symptom pattern requiring extended capture window, (3) clinical decision-making supporting extended vs. standard monitoring. Include relevant literature supporting extended monitoring for the specific clinical indication (syncope, cryptogenic stroke, etc.).
Duplicate billing - same date of service as hookup code or previous interpretation code for same monitoring period
How to appeal: If legitimately separate services (different monitoring periods), submit timeline documentation showing distinct service dates and separate monitoring sessions. If hookup and interpretation were same DOS, verify payer policy allows separate billing; some require all-inclusive billing. Provide device serial numbers if multiple separate monitoring periods to prove distinct services.
Insufficient documentation - interpretation report lacks required elements such as total monitoring time, arrhythmia burden quantification, or correlation with patient symptoms
How to appeal: Submit complete, signed physician interpretation report containing: total monitoring hours, heart rate range (min/max/average), arrhythmia counts with specific types, symptom correlation via patient diary entries, clinical impression, and management recommendations. Include attestation that physician personally reviewed full data set. Reference payer's LCD/NCD requirements if applicable.
Frequently asked questions
What is the Medicare reimbursement rate for CPT code 93247 in 2025?
The 2025 Medicare national average reimbursement rate for CPT 93247 is $234.84 for both facility and non-facility settings. This rate is based on 7.26 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic location due to locality adjustments.
How many days of monitoring does CPT 93247 cover?
CPT 93247 covers external ECG monitoring for more than 7 days up to (but not including) 15 days. The monitoring period must exceed 7 complete days and must be less than 15 days. For monitoring of 48 hours to 7 days, use code 93227; for 15 days or longer, use code 93248.
Can I bill CPT 93247 with the hookup code on the same date of service?
This depends on payer policy. Some payers allow separate billing of hookup codes (93260) and interpretation codes (93247) when performed on different dates, while others consider hookup bundled into the interpretation. When the device is applied and the interpretation is completed weeks later, separate billing is typically appropriate. Always verify payer-specific bundling edits and local coverage determinations.
What is the difference between CPT 93247 and 93227?
The primary difference is monitoring duration. CPT 93227 covers external ECG recording for 48 hours up to 7 days with scanning analysis and report, while CPT 93247 covers more than 7 days up to 15 days. Code selection must match the actual documented monitoring period. The 2025 Medicare rate for 93247 ($234.84) differs from 93227, reflecting the increased work of analyzing longer recording periods.
Does CPT 93247 require a physician to perform the interpretation?
Yes, CPT 93247 requires physician (MD or DO) interpretation and signature. While technicians may perform preliminary scanning and rhythm analysis, the physician must personally review the complete data set, correlate findings with clinical context, and generate the final signed interpretation report. The physician's personal review and signature are mandatory documentation elements for compliant billing.
How do I bill CPT 93247 if the patient only wore the monitor for 10 days instead of the full prescribed 14 days?
If the patient wore the monitor for 10 days, CPT 93247 is the correct code because 10 days falls within the >7 to <15 day range. Document the actual monitoring dates (start and stop) in your interpretation report. You should only consider modifier 52 (reduced services) if the data quality was significantly compromised or if you could not perform a complete analysis due to technical failures, not simply because the patient wore it for fewer than the maximum days in the code descriptor.
What are the RVU values for CPT 93247 in 2025?
For 2025, CPT 93247 has 0 work RVUs, 7.25 practice expense RVUs (both facility and non-facility), 0.01 malpractice RVUs, totaling 7.26 total RVUs. These RVU values are multiplied by the 2025 conversion factor of 32.3465 to arrive at the Medicare payment rate of $234.84. The zero work RVU reflects that this is primarily a technical/practice expense service.