Peri-px device eval & prgr
CPT 93287 covers the evaluation and programming of a pacemaker or implantable defibrillator (ICD) device immediately before, during, or after a surgical procedure. This ensures the device is properly configured for the patient's safety during surgery and functioning correctly afterward.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Bill 93287 separately for both pre-procedure and post-procedure evaluations when device reprogramming occurs
Impact: Can capture $99.62 for both services when medically necessary with proper documentation; use modifier 76 for second service
Document the specific device settings changes made (e.g., mode switch from DDD to DOO, disabling rate response, magnet mode activation)
Impact: Prevents denials for lack of medical necessity; programming changes justify separate billing from routine interrogations
Ensure time and date stamps in device reports clearly show peri-procedural timing (within 24 hours of surgery)
Impact: Establishes medical necessity for 93287 versus routine follow-up codes; crucial for audit defense
Verify the primary procedure is not on the CCI edits exclusion list before billing 93287 separately
Impact: Prevents automatic denials; some cardiac procedures bundle device evaluation into primary code
Bill 93287 in addition to the primary surgical procedure code, not as standalone service
Impact: Medicare requires linkage to a procedure; standalone billing typically results in denial for lack of medical necessity
Capture manufacturer-specific device reports and store in patient record with physician attestation
Impact: Audit protection; CMS requires device-generated reports plus physician interpretation for full reimbursement of $49.81
Common denials
Services not separately payable - bundled into primary procedure code
How to appeal: Submit appeal with documentation showing device evaluation meets criteria for separately identifiable service. Include specific programming changes made, time stamps showing distinct service timing, and reference CPT guidelines stating 93287 is separately reportable for peri-procedural evaluations. Cite modifier 59 or XU usage.
Medical necessity not established - insufficient documentation of why device evaluation was required
How to appeal: Provide operative note showing type of surgery, anesthesia plan, and use of electrocautery. Include cardiology consultation note documenting device type, dependency status, and risk assessment. Reference ACC/HRS guidelines for perioperative device management requiring evaluation.
Incorrect code selection - billed 93287 instead of routine remote or in-office interrogation codes
How to appeal: Clarify timing relationship to surgical procedure with operative report and device interrogation timestamps. Demonstrate programming changes were made specifically for surgical period, not routine monitoring. Reference CPT descriptor emphasizing 'peri-procedural' nature of service.
Duplicate service - multiple device checks same day without justification
How to appeal: Document medical necessity for repeat evaluation (e.g., intra-operative concerns, post-procedure arrhythmia, device alert). Include clinical notes showing changed patient condition requiring second assessment. Attach both device reports showing different findings or settings.
Frequently asked questions
What is the Medicare reimbursement rate for CPT 93287 in 2025?
The 2025 Medicare national average reimbursement rate for CPT 93287 is $49.81 for both facility and non-facility settings. This is based on 1.54 total RVUs multiplied by the 2025 conversion factor of 32.3465.
Can CPT 93287 be billed with the primary surgical procedure code?
Yes, CPT 93287 can and should be billed separately from the primary surgical procedure code when peri-procedural device evaluation is medically necessary. Use modifier 59 or XU to indicate it is a distinct service. However, verify NCCI edits as some cardiac procedures may bundle device evaluation.
What is the difference between CPT 93287 and routine pacemaker interrogation codes?
CPT 93287 is specifically for peri-procedural evaluations involving device reprogramming before, during, or after surgery. Routine interrogation codes (93288-93290 for pacemakers, 93291-93296 for ICDs) are used for scheduled follow-up checks without the surgical context. The key distinction is the temporal relationship to a procedure and programming changes made.
How many times can CPT 93287 be billed for a single surgical procedure?
Typically CPT 93287 can be billed twice per surgical encounter: once for pre-procedure evaluation/programming and once for post-procedure restoration/verification. The second service requires modifier 76 and clear documentation of medical necessity. Billing more than twice requires exceptional circumstances with detailed justification.
What documentation is required to bill CPT 93287 to Medicare?
Required documentation includes device-generated interrogation report with date/time stamps, specific programming changes made, indication for peri-procedural evaluation, physician interpretation and signature, and clear linkage to the surgical procedure. The documentation must show why the device check was medically necessary in relation to the planned surgery.
Does CPT 93287 apply to both pacemakers and ICDs?
Yes, CPT 93287 applies to peri-procedural evaluation and programming of both pacemakers and implantable cardioverter-defibrillators (ICDs). The code descriptor covers all permanent implantable cardiac devices requiring evaluation in the surgical period, regardless of device type or manufacturer.
What are the work RVUs for CPT 93287 in 2025?
CPT 93287 has 0.45 work RVUs, 1.07 practice expense RVUs (both facility and non-facility), and 0.02 malpractice RVUs, totaling 1.54 RVUs in 2025. The relatively low work RVU reflects the brief but technically specialized nature of peri-procedural device management.