Pm device progr eval dual
CPT code 93280 covers the programming and evaluation of a dual-chamber pacemaker or implantable cardioverter-defibrillator (ICD). This is when a healthcare provider checks the device settings, reviews stored data, and adjusts programming as needed during an in-person visit.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Verify chamber designation before coding—93280 is specifically for dual-chamber devices; single-chamber requires 93279 and leadless uses 93264
Impact: Prevents denials and payment adjustments; incorrect chamber coding can result in $20-40 payment variance
Document all required elements: device type/manufacturer, interrogation findings, battery status, lead impedances, sensing/pacing thresholds, and any reprogramming performed
Impact: Complete documentation reduces audit risk and supports medical necessity; missing elements are primary cause of post-payment recoupment
Do not bill 93280 on same date as remote monitoring codes (93296-93299) for same device
Impact: CCI edits bundle remote and in-person services on same date; can result in automatic denial of $75.04 payment
Bill only once per session regardless of time spent; 93280 is not time-based
Impact: Prevents upcoding denials; service is per-encounter not per-unit of time
Ensure 93280 is billed under the supervising physician's NPI when performed by qualified allied health personnel
Impact: Incorrect NPI/credential mismatch can delay payment or trigger credential verification reviews
Check for frequency limitations—most payers allow in-person device checks every 3-12 months depending on device type and patient status
Impact: Medical necessity denials common for checks performed more frequently than coverage policy allows without exceptional documentation
Common denials
Frequency limitation exceeded—in-person check performed too soon after previous evaluation
How to appeal: Submit appeal with documentation of clinical indication (symptoms, device alerts, medication changes, or manufacturer recall/advisory) that necessitated earlier-than-routine evaluation
Incorrect device type—single-chamber device coded as dual-chamber
How to appeal: Review device implant records and manufacturer specifications; submit corrected claim with device model documentation proving dual-chamber configuration
Bundled with same-day E/M service without modifier 25
How to appeal: Resubmit with modifier 25 on E/M code with documentation clearly distinguishing separate medical decision-making beyond device evaluation (e.g., new symptom assessment, medication adjustment)
Insufficient documentation—missing required device parameters or interpretation
How to appeal: Submit complete device interrogation report showing all measured parameters, physician interpretation, and clinical decision-making based on findings
Frequently asked questions
What is the Medicare reimbursement rate for CPT 93280 in 2025?
The 2025 Medicare national average payment for CPT 93280 is $75.04 for both facility and non-facility settings, based on 2.32 total RVUs and the conversion factor of 32.3465.
How often can CPT 93280 be billed for pacemaker checks?
Medicare and most payers allow in-person dual-chamber pacemaker evaluations (93280) approximately every 12 months for routine checks, with more frequent visits allowed for specific clinical indications such as symptoms, device alerts, or end-of-life battery status. Remote monitoring may be required in intervening months.
What is the difference between CPT 93280 and 93279?
CPT 93280 is for dual-chamber pacemaker or ICD programming evaluation (both atrial and ventricular leads), while 93279 is for single-chamber devices (one lead only). The chamber designation must match the actual implanted device configuration.
Can CPT 93280 be billed with an office visit on the same day?
Yes, CPT 93280 can be billed with an E/M service on the same day when a significant, separately identifiable evaluation is performed and documented. Modifier 25 must be appended to the E/M code, and documentation must clearly distinguish the separate medical decision-making.
What RVUs are assigned to CPT 93280 in 2025?
CPT 93280 has 0.77 work RVUs, 1.52 practice expense RVUs (both facility and non-facility), 0.03 malpractice RVUs, for a total of 2.32 RVUs in 2025.
Does CPT 93280 require a physician to perform the service?
The device interrogation can be performed by qualified allied health personnel or technicians, but a physician or qualified healthcare professional must personally review the data, interpret findings, make programming decisions, and document their assessment to bill CPT 93280.
Can CPT 93280 be billed for remote device interrogation?
No, CPT 93280 is exclusively for in-person, face-to-face device evaluations. Remote interrogation and monitoring services use different codes (93296-93299) and cannot be billed on the same date as 93280 for the same device.