CPT 93296Cardiology

Rem interrog evl pm/ids

CPT 93296 covers the professional evaluation and interpretation of data transmitted remotely from a pacemaker or implantable cardioverter-defibrillator (ICD). This is when a physician reviews heart device data sent electronically from a patient's home, without the patient visiting the office.

Showing rates for

National Average

Base Medicare rate

$19.41

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

PE RVU (NF)

0.59

MP RVU

0.01

Total RVU

0.6

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

NCCI bundling edits

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Billing tips

Observe the 30-day interval requirement: 93296 can only be billed once every 30 days per device. Claims submitted before 30 days from previous interrogation will deny.
Impact: Prevents 100% denial of claim; ensures full $19.41 reimbursement per eligible monitoring period
Ensure physician-generated report is in medical record for every 93296 claim. Report must include device type, battery status, lead parameters, arrhythmia summary, and physician interpretation.
Impact: Critical for audit defense; missing documentation can result in 100% recoupment during post-payment audits
Do not bill 93296 in same 30-day period as in-person device checks (93288, 93289, 93295). Choose highest-paying code and ensure proper sequencing.
Impact: Prevents bundling denials; in-person interrogation codes typically reimburse higher ($60-90 range) than remote 93296 at $19.41
Verify patient enrollment in remote monitoring program is documented. Many payers require proof of patient consent and enrollment before authorizing remote interrogation services.
Impact: Prevents denial for lack of medical necessity or missing prerequisites; protects revenue stream for recurring monthly services
Bill separately for pacemaker (single/dual chamber) versus ICD devices using appropriate codes within 93294-93296 family. 93296 is specific to remote interrogation evaluation only.
Impact: Correct code selection ensures proper reimbursement; ICD interrogations may have different documentation requirements
Track manufacturer-specific transmission compliance. Document failed transmissions and patient outreach attempts, as some contracts require minimum transmission rates for continued enrollment.

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 93296 in 2025?

The 2025 Medicare national average reimbursement for CPT 93296 is $19.41 for both facility and non-facility settings. This is based on 0.6 total RVUs multiplied by the 2025 conversion factor of 32.3465.

How often can you bill CPT 93296 for remote pacemaker monitoring?

CPT 93296 can be billed once every 30 days per patient per device. You cannot bill another remote interrogation (93294-93296) or in-person device check (93288, 93289) within the same 30-day period for the same device.

What is the difference between CPT 93296 and 93294?

CPT 93294 is remote interrogation of an implantable cardioverter-defibrillator (ICD) system, while 93296 is remote interrogation of a pacemaker system. The codes differ based on device type being monitored. Both require physician interpretation and follow 30-day frequency limits.

Does CPT 93296 require the patient to be present during the service?

No, CPT 93296 is a remote service where data is transmitted electronically from the patient's device (usually from home) to the monitoring center. The patient does not need to be present during physician interpretation. However, patient enrollment and consent for remote monitoring must be documented.

What documentation is required to bill CPT 93296?

Required documentation includes a physician-signed report with device identification, battery status, lead parameters, sensing/pacing data, arrhythmia summary, physician interpretation, and clinical assessment. The report must be dated and include the interpreting physician's credentials.

Can you bill CPT 93296 with an E/M visit on the same day?

Yes, you can bill an E/M service on the same day as 93296 if the E/M represents a separate, significant, and identifiable service beyond the device interpretation. Use modifier 25 on the E/M code and ensure documentation supports distinct services with separate medical necessity.

What are the RVU values for CPT 93296 in 2025?

CPT 93296 has 0 work RVUs, 0.59 practice expense RVUs (both facility and non-facility), and 0.01 malpractice RVUs, for a total of 0.6 RVUs. This reflects the service being a professional interpretation of remotely transmitted data without direct patient contact.