CPT 93285Cardiology

Prgrmg dev eval scrms ip

CPT 93285 covers the programming and evaluation of a subcutaneous cardiac rhythm monitoring device during an inpatient or observation stay. This is the technical work of adjusting settings on an implanted heart monitor to optimize detection of irregular heart rhythms.

Showing rates for

National Average

Base Medicare rate

$56.93

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)

1.21

MP RVU

0.03

Total RVU

1.76

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Bill only once per hospital admission regardless of length of stay; multiple programming sessions during single admission are bundled
Impact: Prevents denials for duplicate services; second programming attempt during same admission will be denied, potentially costing $56.93
Document specific parameters changed, thresholds adjusted, and clinical rationale for programming to differentiate from simple interrogation (93291)
Impact: Prevents downcoding to interrogation-only code 93291 which reimburses less; maintaining correct code saves the differential
Ensure service is performed in-person during inpatient or observation status; remote monitoring is reported with different codes
Impact: Wrong setting/method billing results in 100% denial; verify patient status (inpatient/observation) before billing
Do not bill on same date as initial device implantation; programming is included in the global surgical package
Impact: Billing with implant results in bundling denial and loss of $56.93 payment
Include device manufacturer, model number, and serial number in documentation to support medical necessity and device identification
Impact: Reduces audit risk and speeds claims processing; missing device details trigger 15-20% higher audit rates
For Medicare patients, ensure medical necessity supports inpatient programming rather than deferring to outpatient setting
Impact: Payers may deny as not medically necessary if programming could wait until discharge; clear acute indication prevents denial

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 93285?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the difference between CPT 93285 and 93291?

CPT 93285 includes both interrogation and programming of a subcutaneous cardiac monitor in an inpatient setting, while 93291 covers interrogation only without parameter changes. If the device settings are modified or thresholds adjusted, use 93285. If only data is reviewed without programming changes, use 93291.

How much does Medicare pay for CPT 93285 in 2025?

The 2025 Medicare national average reimbursement for CPT 93285 is $56.93 for both facility and non-facility settings. This rate is based on 1.76 total RVUs (0.52 work RVU, 1.21 PE RVU, 0.03 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can I bill 93285 multiple times during the same hospital admission?

No, CPT 93285 should typically be billed only once per hospital admission regardless of length of stay. Multiple programming sessions during a single continuous inpatient encounter are considered part of the same service. Separate admissions require discharge and readmission to support multiple billings.

Can CPT 93285 be billed with an E/M code on the same day?

Yes, CPT 93285 can be billed with a separately identifiable E/M service on the same day when modifier 25 is appended to the E/M code. Documentation must clearly support that the E/M service was distinct from the device programming and addressed other significant patient issues beyond the programming procedure itself.

What devices are appropriate for billing CPT 93285?

CPT 93285 is used for subcutaneous implantable cardiac monitors (ICMs) such as Medtronic Linq, Linq II, Boston Scientific LUX-Dx, Abbott Confirm Rx, and similar loop recorders. It is not used for pacemakers, ICDs, or external monitors which have different code sets.

Is CPT 93285 a global code or can it be split into professional and technical components?

CPT 93285 is primarily a professional service code representing the physician work of programming and evaluation. In the inpatient setting, both the facility and non-facility rates are identical at $56.93, and the code is typically billed as a complete service rather than split into components.

How long after device implantation can I bill CPT 93285?

Programming performed on the same day as device implantation is included in the implant procedure's global package and should not be separately billed. Subsequent programming during later admissions or encounters outside the implant date can be billed with 93285 when medically necessary and properly documented.