CPT 93268Cardiology

Ecg record/review

CPT code 93268 covers the recording and physician review of continuous heart rhythm monitoring data, typically from a wearable monitor worn for up to 48 hours. This is the professional interpretation service where a cardiologist analyzes the recorded ECG data and provides a medical report.

Showing rates for

National Average

Base Medicare rate

$163.35

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

0.52

PE RVU (NF)

4.49

MP RVU

0.04

Total RVU

5.05

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

NCCI bundling edits

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Billing tips

Verify the monitoring duration is clearly documented as up to 48 hours; if monitoring extends beyond 48 hours, use code 93270 instead for 48-72 hour monitoring
Impact: Using wrong duration code results in automatic denial or downcoding; 93270 reimburses at different rate and incorrect code selection requires claim resubmission causing 30-45 day payment delays
Ensure the physician interpretation report includes all required elements: patient identification, indication for study, monitoring dates/times, total monitoring hours, rhythm analysis with representative strips, symptom-event correlation, and summary with clinical recommendations
Impact: Missing any required element can trigger medical review or denial; complete documentation supports the full $163.35 reimbursement and reduces audit risk by approximately 70%
Bill 93268 only for the professional interpretation component; the hookup/recording (93270) and scanning/analysis (93271) are separate technical components that should not be billed by the interpreting physician unless they also provide the technical service
Impact: Incorrect billing of bundled services or double-billing technical and professional components results in denials and potential compliance flags; proper component billing ensures clean claims
Document the medical necessity clearly in the order and interpretation, linking to specific symptoms (palpitations, syncope, dizziness) or clinical conditions (post-MI, suspected arrhythmia, medication adjustment)
Impact: Lack of medical necessity documentation is the #1 reason for denial on audit; strong medical necessity reduces denial rate from 15-20% to under 5%
Submit claims within the timely filing limits and include the specific dates of service for the monitoring period, not just the interpretation date
Payer-specific timely filing varies from 90-365 days; late filing results in automatic denial with no appeal option; proper date documentation prevents confusion about service timing

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Frequently asked questions

What is CPT code 93268 used for?

CPT 93268 is used to bill for the physician's professional interpretation and report of external electrocardiographic (ECG) recording by continuous rhythm monitoring for up to 48 hours. This represents the cardiologist's work in analyzing all recorded heart rhythm data, identifying any abnormalities, correlating findings with patient symptoms, and generating a comprehensive report with clinical recommendations.

How much does Medicare pay for CPT 93268 in 2025?

Medicare pays $163.35 for CPT 93268 in 2025 based on the national average rate. This rate applies to both facility and non-facility settings and is calculated using 5.05 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary based on geographic location and payer-specific fee schedules.

What is the difference between CPT 93268 and 93270?

CPT 93268 is the professional component (physician interpretation only) for up to 48 hours of monitoring, while 93270 represents the complete service including both technical and professional components for 48-72 hours of monitoring. Code 93268 is typically used when the interpreting physician bills separately from the facility providing the equipment and recording service.

Can CPT 93268 be billed with modifier 26?

CPT 93268 already represents only the professional component, so modifier 26 is generally not needed or appropriate. The code descriptor itself indicates this is for physician analysis, review, and interpretation without the technical recording component. Some payers may have specific requirements, so verify individual payer policies.

What documentation is required to bill CPT 93268?

Documentation must include a complete physician interpretation report with patient identification, clinical indication, monitoring dates and duration, comprehensive rhythm analysis with representative ECG strips, correlation of patient symptoms with recorded events, quantification of any arrhythmias detected, clinical assessment of findings, treatment recommendations, and physician signature. Incomplete reports are a primary cause of denials and audit findings.

How often can CPT 93268 be billed for the same patient?

Medicare and most commercial payers typically allow one extended cardiac monitoring study per month per patient under normal circumstances. More frequent monitoring requires clear documentation of medical necessity, such as new symptoms, medication changes requiring assessment, or prior study technical failures. Repeat studies within 30 days often trigger automatic review or denial without exceptional documentation.

What are the RVUs for CPT code 93268?

CPT 93268 has 5.05 total RVUs for 2025, consisting of 0.52 work RVUs, 4.49 practice expense RVUs (both facility and non-facility), and 0.04 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A file released December 23, 2024.