Prgrmg eval implantable dfb
CPT 93282 covers the programming and evaluation of an implantable cardioverter-defibrillator (ICD), a device that monitors heart rhythm and delivers shocks when needed. This code is used when a healthcare provider checks the device settings, reviews stored data, and adjusts programming parameters.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Verify the exact device type before coding - 93282 is specifically for single and dual-chamber ICDs only, not subcutaneous ICDs (93261) or pacemakers
Impact: Incorrect device type coding results in 100% denial and requires claim resubmission with corrected code
Bill 93282 only once per 90-day period per Medicare guidelines unless medically necessary circumstances are clearly documented
Impact: More frequent billing without documentation triggers audit flags and potential recoupment of $76.01 per unauthorized claim
Document the face-to-face encounter requirement - remote interrogations are not billable with 93282
Impact: Missing face-to-face documentation results in denial; use remote monitoring codes (93295-93296) for non-face-to-face services instead
Ensure documentation includes all required elements: device interrogation, battery/lead status, stored data review, and any reprogramming performed
Impact: Incomplete documentation increases audit risk and may result in downcoding or full denial of $76.01
When billing with an E/M service on the same day, document the separate medical necessity and use modifier 25 on the E/M code, not on 93282
Impact: Improper modifier placement results in E/M denial; proper documentation supports an additional $50-$200 depending on E/M level
Bill the appropriate facility vs non-facility setting based on where service is performed - both rates are $76.01 for 93282, but documentation requirements differ
Impact: Ensures compliance with place of service requirements and prevents audit issues
Common denials
Frequency limitation exceeded - billed more than once per 90-day period without medical necessity documentation
How to appeal: Submit appeal with documentation of intervening events such as ICD shocks, symptoms, medication changes, or other clinical indications requiring additional programming evaluation outside routine schedule
Incorrect device type - 93282 billed for subcutaneous ICD or pacemaker system
How to appeal: Review device documentation to confirm device type; if coding error, submit corrected claim with appropriate code (93260-93261 for subcutaneous ICD, 93279-93281 for pacemakers). If device type is correct, submit device implant records proving transvenous ICD system.
Missing or insufficient documentation of face-to-face encounter or required evaluation elements
How to appeal: Submit complete medical record documentation including date of service, face-to-face physician/QHP note, device interrogation report showing all parameters, stored data review, and any programming changes made with clinical rationale
Bundling denial when billed with E/M service on same date without modifier 25 or with insufficient documentation of separate service
How to appeal: Resubmit with modifier 25 on E/M code and documentation clearly showing the E/M service addressed separate medical issues beyond the device evaluation, with distinct history, exam, and medical decision-making components
Frequently asked questions
What is the Medicare reimbursement rate for CPT 93282 in 2025?
The 2025 Medicare national average payment for CPT 93282 is $76.01 for both facility and non-facility settings, based on 2.35 total RVUs and a conversion factor of 32.3465.
How often can CPT 93282 be billed for the same patient?
Medicare typically covers 93282 once per 90-day period for routine device checks. More frequent billing requires documentation of medical necessity such as ICD shocks, symptoms, medication changes, or device alerts requiring additional programming evaluation.
What is the difference between CPT 93282 and 93289?
CPT 93282 is for in-person programming device evaluation of an implantable defibrillator, while 93289 is for remote interrogation only. 93282 requires a face-to-face encounter and typically includes device reprogramming capability, whereas 93289 is for data downloads without face-to-face service.
Can CPT 93282 be billed with an office visit on the same day?
Yes, CPT 93282 can be billed with an E/M service on the same day when a separately identifiable evaluation and management service is provided and documented. Modifier 25 must be appended to the E/M code, and documentation must clearly show distinct services.
What type of defibrillator devices are covered under CPT 93282?
CPT 93282 covers programming evaluations for single-chamber and dual-chamber implantable cardioverter-defibrillators (ICDs) with transvenous leads. Subcutaneous ICDs use different codes (93260-93261), and pacemakers without defibrillator capability use 93279-93281.
Does CPT 93282 include both interrogation and reprogramming?
Yes, CPT 93282 includes device interrogation, analysis of all functions, review of stored data, and any medically necessary reprogramming. There is no separate code for reprogramming alone - it is bundled into the evaluation service.
What documentation is required to support billing CPT 93282?
Required documentation includes face-to-face encounter confirmation, complete device interrogation report with all parameters, battery status, lead impedances, stored arrhythmia review, any programming changes with clinical rationale, device assessment, and physician interpretation with signature.