CPT 93286Cardiology

Peri-px eval pm/ldls pm ip

CPT 93286 covers the technical evaluation and programming of a pacemaker or implantable cardioverter-defibrillator (ICD) immediately before or after a medical procedure. This ensures the device settings are optimized for the patient's safety during procedures like surgery.

Showing rates for

National Average

Base Medicare rate

$43.02

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

0.3

PE RVU (NF)

1.01

MP RVU

0.02

Total RVU

1.33

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

NCCI bundling edits

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Billing tips

Document both pre-procedure device settings AND post-procedure restoration separately with time stamps to justify peri-procedural medical necessity
Impact: Reduces denial risk by 60-70%; payers commonly deny when only single interrogation documented
Bill 93286 only for inpatient encounters; use 93287 for outpatient/office peri-procedural evaluations to avoid automatic denials
Impact: Prevents 100% denial; place of service must match code descriptor (21 for inpatient, 22 for outpatient surgical)
Append modifier 59 when billing with same-day diagnostic device interrogations (93288-93290) to unbundle services
Impact: Can recover $43.02 that would otherwise be bundled; requires separate documentation of distinct clinical purpose
Link to appropriate surgical/procedural CPT code in documentation to establish medical necessity for device reprogramming
Impact: Reduces medical necessity denials by 40-50%; demonstrate why device changes were required for specific procedure
Use device manufacturer's proprietary interrogation report printouts as supporting documentation, not as substitute for physician interpretation
Impact: Strengthens audit defense but physician must add interpretation note; reports alone increase audit risk
For patients with both pacemaker and ICD, bill only the more complex device evaluation (ICD takes precedence)
Impact: Prevents duplicate billing denials; ICD codes (93287, 93289) reimburse higher than pacemaker codes

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 93286 in 2025?

The 2025 Medicare national average payment for CPT 93286 is $43.02 for both facility and non-facility settings. This rate is based on 1.33 total RVUs multiplied by the 2025 conversion factor of $32.3465.

What is the difference between CPT 93286 and 93287?

CPT 93286 is used for peri-procedural pacemaker evaluations in inpatient settings (place of service 21), while 93287 is for outpatient peri-procedural evaluations. Using the wrong code for the setting will result in claim denial. Verify the patient's admission status before selecting the appropriate code.

Can CPT 93286 be billed on the same day as a routine device interrogation?

Yes, but only if the peri-procedural evaluation is distinct from routine monitoring and serves a separate clinical purpose. You must append modifier 59 and provide separate documentation showing the pre-procedural device reprogramming for surgical safety was medically necessary and different from routine device checking.

How many RVUs is CPT 93286 worth in 2025?

CPT 93286 has 1.33 total RVUs in 2025, consisting of 0.30 work RVUs, 1.01 practice expense RVUs (both facility and non-facility), and 0.02 malpractice RVUs according to the CMS Physician Fee Schedule.

What documentation is required to bill CPT 93286?

Required documentation includes pre-procedure device interrogation with baseline settings, specific programming changes made for the procedure, medical necessity justification, post-procedure device restoration, physician interpretation and signature, and linkage to the surgical/procedural CPT code. Both pre and post evaluations must be documented separately with time stamps.

Can nurse practitioners or physician assistants bill CPT 93286?

Yes, qualified non-physician practitioners with appropriate device management training can bill 93286 under their own NPI or incident-to a supervising physician, depending on state scope of practice laws and payer policies. Many facilities require formal device certification or documented training in cardiac rhythm management.

Why was my CPT 93286 claim denied for bundling?

Common bundling denials occur when 93286 is billed with routine device checks (93288-93290) on the same day without proper modifier usage or documentation separation. To prevent bundling, use modifier 59, document distinct clinical purposes, and clearly show the peri-procedural evaluation addressed surgical safety concerns separate from routine monitoring.