Interrogate subq defib
CPT 93261 covers the interrogation (testing and analysis) of a subcutaneous implantable cardioverter-defibrillator (S-ICD), a device implanted under the skin to monitor and correct dangerous heart rhythms. This is a routine check performed in-office or remotely to ensure the device is functioning properly.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Verify that device is truly a subcutaneous ICD before using 93261; transvenous ICDs use different codes (93289, 93295-93296)
Impact: Prevents immediate denials due to device mismatch; subcutaneous and transvenous systems have distinct code families
Document all required elements: device type/manufacturer, battery voltage and impedance, lead integrity, stored episodes reviewed, and any programming changes made
Impact: Complete documentation supports medical necessity and prevents $67.28 payment recoupment during audits
Limit in-person interrogations to medically necessary visits; routine quarterly checks may be denied if performed more frequently than manufacturer/clinical guidelines recommend
Impact: Medicare typically covers 4 in-person interrogations annually; exceeding this may trigger denials or reduce annual revenue by $67.28 per denied visit
Do not bill 93261 on the same day as remote interrogation codes (93294) unless separate medical necessity is clearly documented
Impact: Bundling edits may deny one service; ensure 90-day gap between remote and in-person checks unless symptomatic indication exists
When billing with modifier 25 for E/M service, document symptoms or conditions beyond routine device assessment that required separate evaluation
Impact: Supports additional $50-$200+ E/M reimbursement beyond base $67.28; inadequate documentation leads to modifier 25 denials
Bill on date of physician interpretation and report completion, not date of technical data download if different
Ensures timely filing; some payers have 30-day filing deadlines from date of service
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