CPT 93288Cardiology

Interrog evl pm/ldls pm ip

CPT 93288 covers the in-person evaluation and interrogation of a pacemaker or leadless pacemaker system to check battery status, lead function, and stored diagnostic data. This service is performed in a hospital, clinic, or office setting with the patient present.

Showing rates for

National Average

Base Medicare rate

$53.70

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

0.43

PE RVU (NF)

1.21

MP RVU

0.02

Total RVU

1.66

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

NCCI bundling edits

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Billing tips

Verify frequency limitations before billing - Medicare typically covers in-person interrogations every 3 months for pacemakers, with remote monitoring in between
Impact: Prevents denials for exceeding frequency limits; frequency violations account for approximately 25-30% of 93288 denials
Do not bill 93288 on the same day as remote interrogation codes (93294-93296) for the same device - these are mutually exclusive
Impact: Avoids bundling denials and potential fraud flags; one service will be denied at $53.70
Document the specific reason for in-person interrogation rather than remote monitoring, especially if performed outside normal schedule
Impact: Supports medical necessity for off-cycle evaluations and reduces audit risk; improves appeal success rate by 60-70%
Ensure documentation includes all required elements: battery status, lead impedance, programmed parameters, stored data review, and clinical assessment
Impact: Complete documentation prevents downcoding or denial; incomplete records may result in $53.70 loss per encounter
Bill 93288 separately from E/M services only when device interrogation is not the primary reason for visit; if primary, it is bundled into E/M
Impact: When appropriately separated with modifier 25 on E/M, can capture additional $100-300 depending on E/M level
For hospital inpatients, bill 93288 only once per admission unless clinical change necessitates repeat interrogation with clear documentation
Impact: Prevents denial of duplicate services; each denied claim represents $53.70 loss

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 93288 in 2025?

The 2025 Medicare national average payment rate for CPT 93288 is $53.70 for both facility and non-facility settings, based on 1.66 total RVUs and the conversion factor of 32.3465.

How often can CPT 93288 be billed for pacemaker interrogation?

Medicare typically covers in-person pacemaker interrogations (93288) every 3 months or quarterly. More frequent interrogations require documentation of medical necessity such as new symptoms, device alerts, or clinical changes. Remote monitoring can be performed in the months between in-person checks.

Can CPT 93288 be billed with an office visit on the same day?

Yes, but only if the device interrogation is a separately identifiable service from the evaluation and management (E/M) visit. If the interrogation is the primary reason for the visit, it is considered bundled into the E/M service. When billing both, append modifier 25 to the E/M code and ensure separate documentation for each service.

What is the difference between CPT 93288 and 93294?

CPT 93288 is for in-person pacemaker interrogation with the patient present in the office or clinic. CPT 93294 is for remote monitoring interrogation where device data is transmitted electronically and reviewed without a face-to-face encounter. These codes cannot be billed on the same day for the same device.

Does CPT 93288 include pacemaker programming?

No, CPT 93288 covers only the interrogation and evaluation of the pacemaker system. If programming changes are made during the visit, you must bill a separate programming code (93279 for single chamber, 93280 for dual chamber, or 93281 for multiple lead) in addition to 93288.

What documentation is required to bill CPT 93288?

Required documentation includes device identification, battery status and longevity estimate, lead impedance values, programmed parameters, review of stored diagnostic data, rhythm strips or event logs, physician interpretation of findings, clinical correlation, and medical necessity for the interrogation. A complete interrogation report plus physician attestation is essential.

Can CPT 93288 be used for leadless pacemaker interrogation?

Yes, CPT 93288 is appropriate for both conventional pacemakers and leadless pacemaker systems. The code descriptor specifically includes 'leadless pacemaker system' along with standard single and dual chamber pacemakers. The same documentation and billing rules apply regardless of pacemaker type.