CPT 93798Cardiology

Phys/qhp op car rhab w/ecg

CPT code 93798 covers cardiac rehabilitation sessions supervised by a physician or qualified health professional with continuous ECG monitoring. This is used for patients recovering from heart attacks, heart surgery, or other cardiac events who need monitored exercise therapy.

Showing rates for

National Average

Base Medicare rate

$24.58

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

0.28

PE RVU (NF)

0.46

MP RVU

0.02

Total RVU

0.76

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

NCCI bundling edits

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Billing tips

Verify facility vs. non-facility setting determination before billing, as this creates a $11.64 (47%) payment difference per session
Impact: Incorrect place of service code can result in underpayment of $11.64 per session; over 36 sessions this equals $419.04 in lost revenue per patient
Document the specific physician or QHP providing direct supervision for each session by name and credentials, with time stamps showing they were on-site and immediately available
Impact: Missing supervision documentation is the #1 audit trigger; can result in 100% recoupment of all payments if supervision cannot be verified
Ensure the patient has a qualifying diagnosis (ICD-10 codes I21.x, I25.x, I50.x, Z95.x, etc.) documented in the medical record and on the claim
Impact: Non-qualifying diagnosis will result in claim denial; approximately 12% of cardiac rehab denials are diagnosis-related
Bill only one unit (1) of 93798 per session per day; do not confuse with time-based billing or attempt to bill multiple units for longer sessions
Impact: Billing multiple units will result in automatic denial of additional units; code is per-session not per-time-unit regardless of session length
Maintain contemporaneous ECG monitoring strips or telemetry recordings for each session as audit documentation, with interpretation notes by supervising professional
Impact: Lack of ECG documentation can trigger 100% claim recoupment; CMS audits require proof of continuous monitoring for code 93798 vs. 93797
Track and document the 36-session Medicare benefit limit (or 72 sessions for chronic heart failure), obtaining prior authorization for sessions beyond the standard benefit

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Frequently asked questions

What is the difference between CPT 93798 and 93797?

CPT 93798 includes continuous ECG monitoring with physician or qualified health professional supervision, while 93797 also includes continuous ECG monitoring but does not require physician/QHP supervision (can be supervised by an exercise physiologist or nurse). The supervision level determines which code to use, with 93798 having higher reimbursement due to the physician/QHP requirement. The 2025 Medicare rate for 93798 is $24.58 (non-facility) versus approximately $19-20 for 93797.

How many cardiac rehab sessions does Medicare cover with CPT 93798?

Medicare covers up to 36 sessions of cardiac rehabilitation (CPT 93798) over 36 weeks for qualifying cardiac conditions such as heart attack, bypass surgery, valve surgery, angioplasty, or heart transplant. For patients with chronic heart failure, Medicare covers up to 72 sessions. Sessions beyond these limits require prior authorization and documented medical necessity showing the patient requires extended treatment.

Can CPT 93798 be billed twice on the same day?

Generally, CPT 93798 should only be billed once per day as it represents one cardiac rehabilitation session. Billing twice in one day would require exceptional circumstances (such as an interrupted first session requiring restart) and modifier 76 (repeat procedure by same provider) or 77 (repeat procedure by different provider), along with detailed documentation justifying the medical necessity of two separate sessions on the same date.

What qualifies as direct supervision for CPT 93798?

Direct supervision for CPT 93798 requires a physician or qualified health professional (NP, CNS, PA, or other licensed professional) to be immediately available and interruptible during the cardiac rehabilitation session. The supervisor must be physically present in the facility and able to provide direct assistance if needed, though they need not be in the same room continuously. Documentation must include the supervisor's name, credentials, and attestation of on-site presence during the session.

What diagnoses qualify for CPT 93798 cardiac rehabilitation?

Medicare covers CPT 93798 for patients with documented acute myocardial infarction (within 12 months), coronary artery bypass surgery, current stable angina pectoris, heart valve repair/replacement, percutaneous coronary interventions (PCI), heart or heart-lung transplant, or stable chronic heart failure (NYHA class II-IV). The qualifying diagnosis must be documented with appropriate ICD-10 codes (I21.x, I25.x, I50.x, Z95.x series) and linked to the cardiac rehab claim.

Is prior authorization required for CPT 93798?

Prior authorization requirements for CPT 93798 vary by payer. Medicare typically does not require prior authorization for the initial 36 sessions (or 72 for chronic heart failure patients) when a qualifying diagnosis is documented, but sessions beyond these limits require medical review and justification. Many Medicare Advantage plans and commercial insurers do require prior authorization before starting cardiac rehabilitation. Verify specific payer requirements before initiating treatment to avoid denials.

What is the 2025 Medicare reimbursement rate for CPT 93798?

The 2025 Medicare national average reimbursement for CPT 93798 is $24.58 for non-facility settings (physician offices, dedicated cardiac rehab centers) and $12.94 for facility settings (hospital outpatient departments). The code has a total RVU of 0.76 (Work RVU: 0.28, Non-facility PE RVU: 0.46, Facility PE RVU: 0.10, MP RVU: 0.02) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic location and individual Medicare Administrative Contractor (MAC) local coverage determinations.