CPT 93284Cardiology

Prgrmg eval implantable dfb

CPT code 93284 covers the programming and evaluation of an implantable cardioverter-defibrillator (ICD), which is a device that monitors heart rhythm and delivers shocks when dangerous rhythms are detected. This code is used when a physician or qualified healthcare professional adjusts the device settings and reviews its data.

Showing rates for

National Average

Base Medicare rate

$100.92

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

1.25

PE RVU (NF)

1.82

MP RVU

0.05

Total RVU

3.12

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

NCCI bundling edits

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Billing tips

Bill 93284 only for in-person evaluations; use remote monitoring codes (93295-93296) for transmissions reviewed without face-to-face encounter
Impact: Prevents denials and recoupment; improper use of 93284 for remote checks is a top audit target with potential for 100% claim denial
Ensure documentation includes all required elements: device type identified, battery voltage/status, lead impedances, sensing and pacing thresholds, review of stored events/episodes, and any reprogramming performed with rationale
Impact: Complete documentation supports medical necessity and prevents downcoding; missing elements can trigger $100.92 denial
Observe frequency limitations: Medicare typically covers in-person ICD interrogations every 3 months (90 days); billing more frequently requires exceptional documentation of medical necessity
Impact: Prevents frequency denials; improper billing intervals account for 30-40% of 93284 denials worth $100.92 each
Do not bill 93284 on the same day as ICD implantation (33249, 33240) or generator replacement (33262-33264) during the global period; interrogation is included in the surgical package
Impact: Avoids bundling denials and potential fraud allegations; unbundling can trigger audits and recoupment of $100.92 plus penalties
When billing with modifier 25 for a separate E/M, document the distinct nature of the office visit addressing issues beyond routine device management, such as new symptoms, medication management, or unrelated conditions
Impact: Supports additional E/M payment of $50-$200+; weak documentation results in E/M denial while 93284 is typically paid
Verify whether payer requires prior authorization for routine device checks; some Medicare Advantage and commercial plans have instituted prior auth requirements for 93284

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 93284 in 2025?

The 2025 Medicare national average reimbursement for CPT 93284 is $100.92 for both facility and non-facility settings. This rate is based on 3.12 total RVUs (1.25 work RVU, 1.82 practice expense RVU, 0.05 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

How often can you bill CPT 93284 for ICD interrogation?

Medicare typically allows in-person ICD interrogations (93284) once every 90 days (approximately every 3 months) as routine follow-up. More frequent billing requires exceptional documentation of medical necessity, such as ICD shocks, device alerts, lead malfunction concerns, or significant clinical status changes requiring parameter adjustment.

What is the difference between CPT 93284 and 93295?

CPT 93284 is used for in-person ICD interrogation with the patient present in the clinic, while 93295 is for remote interrogation of ICD data transmitted electronically and reviewed without a face-to-face encounter. The key distinction is whether the patient is physically present for hands-on device evaluation versus remote data review.

Can you bill an E/M code with CPT 93284 on the same day?

Yes, you can bill a separate E/M service with 93284 on the same day using modifier 25, but only when the E/M represents a significant, separately identifiable service beyond the routine device check. The E/M must address distinct clinical issues such as new symptoms, medication management, or unrelated conditions, with clear documentation of the separate medical decision-making.

What documentation is required to support CPT 93284?

Documentation must include device identification, battery status, all lead impedances, pacing/sensing thresholds, review of stored arrhythmias and therapy history, current programmed parameters, any reprogramming performed with rationale, physician interpretation correlating findings with clinical status, and a signed written report. Missing any of these elements risks denial or downcoding.

Do you need a physician present to bill CPT 93284?

A physician or qualified NPP does not need to perform the technical interrogation but must provide direct supervision, personally interpret the results, correlate findings with the patient's clinical condition, and produce a signed written report. Technician-only interrogations without physician interpretation do not meet the requirements for billing 93284.

Can CPT 93284 be billed during the global period after ICD implantation?

No, CPT 93284 should not be billed during the 90-day global period following ICD implantation or generator replacement procedures. Device interrogations performed during this period are considered included in the surgical package unless performed for a truly unrelated indication, which is rare and requires exceptional documentation with modifier 24.