CPT 93290Cardiology

Interrog dev eval icpms ip

CPT 93290 covers the in-person evaluation and interrogation of an implantable cardioverter-defibrillator (ICD) or pacing cardioverter-defibrillator (ICPMS) system in a hospital or clinic setting. The healthcare provider downloads and analyzes the device data to check heart rhythm recordings and device function.

Showing rates for

National Average

Base Medicare rate

$50.46

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)

1.1

MP RVU

0.03

Total RVU

1.56

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

NCCI bundling edits

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Billing tips

Bill 93290 only for in-person interrogations; use remote monitoring codes (93295-93296) for remote interrogations to avoid denials
Impact: Prevents automatic denials and recoupment; 93295 pays $21.33 vs $50.46 for 93290, so correct code selection impacts revenue by 136%
Document the specific reason for the in-person interrogation (pre-op clearance, device alert, symptoms, admission protocol) to establish medical necessity
Impact: Reduces denial rate by 40-60% according to carrier audits; missing medical necessity is the #1 denial reason
Ensure the full interrogation report is in the medical record, including all device parameters, stored events, battery status, and lead impedances
Impact: Comprehensive documentation prevents downcoding and supports appeals; incomplete reports lead to 25-35% denial rate
Do not bill 93290 on the same day as remote monitoring transmission codes (93295-93296) for the same device
Impact: NCCI edits bundle these services; billing both results in automatic denial of the lower-paying code and potential audit flags
Verify the device type before coding; use 93289 for pacemakers without defibrillator function and 93290 for ICDs or combined pacing/defibrillator systems
Impact: Incorrect device coding causes denials and delays; 93289 and 93290 have identical reimbursement but different clinical criteria
Bill once per hospitalization unless separate medical necessity exists for repeat interrogation (new symptoms, device reprogramming, post-procedure check)
Impact: Medicare typically allows one interrogation per admission; additional interrogations without clear justification face 80%+ denial rates

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 93290 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 93290 is $50.46 for both facility and non-facility settings, based on 1.56 total RVUs and the 2025 conversion factor of 32.3465.

What is the difference between CPT 93290 and 93289?

CPT 93290 is for in-person interrogation of an implantable cardioverter-defibrillator (ICD) or combined pacing/defibrillator system, while 93289 is for pacemaker-only devices without defibrillator capability. Both have identical 2025 Medicare reimbursement of $50.46.

Can you bill CPT 93290 for remote ICD interrogation?

No, CPT 93290 is exclusively for in-person interrogations using a device programmer. Remote ICD interrogations should be billed using CPT 93295 (initial setup) or 93296 (subsequent remote interrogations), which have different reimbursement rates.

How many times can CPT 93290 be billed during one hospital admission?

Medicare typically covers one in-person ICD interrogation per hospitalization. Additional interrogations during the same admission require separate medical necessity documentation, such as new symptoms, device reprogramming, or post-procedure device assessment, and face higher scrutiny.

What documentation is required to bill CPT 93290?

Required documentation includes the complete device interrogation report with battery status, lead parameters, stored arrhythmia data, programmed settings, physician interpretation, medical necessity for the interrogation, and confirmation that the service was performed in-person with a device programmer.

Can CPT 93290 be billed with an E/M code on the same day?

Yes, but the E/M service and device interrogation must be separately identifiable and documented. The device interrogation is typically included in hospital admission or pre-operative evaluations unless performed for a distinct reason requiring separate assessment and interpretation.

What are the RVUs for CPT code 93290 in 2025?

CPT 93290 has 2025 RVU values of 0.43 work RVU, 1.1 practice expense RVU (both facility and non-facility), and 0.03 malpractice RVU, totaling 1.56 RVUs, which translates to $50.46 Medicare reimbursement at the national average rate.