When a patient comes to your cardiology practice complaining of unexplained heart palpitations or episodes of dizziness, what’s your next step? For many healthcare providers, the answer involves continuous cardiac monitoring. However, oftentimes, the insurance claims for these monitoring services are denied. Reason? Getting the minor details wrong.
CPT code 93225 represents one such procedure. That’s why we have created this detailed guide on 93225 billing. By the end of this guide, you will have all the necessary information to file this code successfully. So, let’s start.
CPT Code 93225 – Description
CPT code 93225 is defined as:
“External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection).”
Code 93225 is a cardiology billing code. It is used to bill the technical component of continuous external electrocardiographic (ECG) recording (Holter monitoring) by real-time rhythm recording and storage, which can last for up to 48 hours.
93225 is specifically for the recording part of the procedure. This includes connecting the monitoring device to the patient, the actual continuous recording period, and the disconnection of the device.
The procedure itself is simple. Usually, it is carried out by a 12-lead Holter monitor that continuously records the heart’s electrical activity while patients go about their normal daily activities. The device records every heartbeat during the monitoring period. Based on the data, a report is created, which the physicians can later analyze.
It’s worth noting that CPT 93225 specifically excludes the analysis and physician interpretation of the recorded data.
Scenarios Where CPT Code 93225 is Applicable
CPT code 93225 is mostly used in scenarios where continuous external electrocardiographic recording (telemetry) is performed by a facility that owns the equipment. Still confused? Let’s explain this with the help of some real-world scenarios.
Unstable Angina
Suppose a 60-year-old patient comes to a cardiology practice. The patient complains of unpredictable chest pain that occurs even at rest and has worsened over the past week. The patient also shares that during the pain, he feels shortness of breath and cold sweats. After a detailed evaluation of the symptoms, the cardiologist suspects unstable angina. It is a serious condition where the heart muscle doesn’t receive adequate blood flow.
To monitor the patient’s cardiac rhythm and detect any arrhythmias or ischemic changes during these episodes, the physician orders a 48-hour Holter monitor recording through a patch-type monitor. However, the recording equipment is not available in the practice. So, the patient gets it from another cardiac practice and brings the report back to the physician. In this scenario, the primary cardiologist can bill the service and interpretation of the report via CPT code 93227. The facility that connected and disconnected the device can bill the technical component with CPT code 93225.
Evaluation of Cardiac Arrhythmias
Let’s consider another scenario. Suppose a patient with a history of endocardial fibroelastosis arrives at the cardiac center. He explains to the physician that he keeps getting repeated episodes of palpitations, dizziness, and occasional syncope. To capture any intermittent rhythm abnormalities that may be causing these symptoms, the cardiologist prescribes continuous ECG monitoring for 48 hours.
However, a third-party facility owns the wearable device and gathers the real-time cardiac data. In this case, the facility can use CPT code 93225 to bill the technical part of the ECG, while the ordering physician can bill for the professional component after interpreting the report.
Applicable Modifiers for CPT Code 93225
The following modifiers are most commonly used with CPT code 93225:
| Modifier Name | Description | When To Use It |
|---|---|---|
| Modifier 52 | Reduced Services | Used when Holter monitoring lasts less than 12 hours. |
| Modifier 59 | Distinct Procedural Service | Indicates that 48-hour Holter monitoring is a separate and distinct service from other procedures performed on the same day. |
| Modifier 76 | Repeat Procedure (Same Provider) | Applied when the same provider repeats the external Holter monitoring on the same day on the same patient, subsequent to the original procedure. |
| Modifier 77 | Repeat Procedure (Different Provider) | Similar to Modifier 76, but used when a different provider repeats the CPT 93225 procedure on the same day. |
Please note that since code 93225 represents only the technical part of the service, there is no need to append modifier TC or 26.
CPT Code 93225 – Billing & Reimbursement Guidelines
Getting denials for CPT code 93225? You might be missing the minor details. The following are some billing guidelines and vital points to remember while filing claims for 93225:
Mention the Correct Date of Service
According to CMS guidelines, when submitting claims for the ECG recording only (CPT 93225), the date of service (DOS) should be the date the monitor was applied to the patient, not the date of interpretation.
This differs from the global code 93224, where the date of physician review serves as the date of service.
Meet the Documentation Requirements
Like all other codes, appending the relevant documentation is essential for 93225 claims. Without proper documentation and medical records, your claims are sure to be denied. Make sure that:
- All records are legible, maintained in the patient’s chart, and available upon request
- Every page has proper patient identification and dates of service
- Physician or qualified practitioner provides legible signatures
- ICD-10-CM codes are supported by medical record evidence
- CPT/HCPCS codes accurately describe the performed service
- Medical necessity for the specific monitoring duration (>24 hours) is evident
- Specific symptoms are documented, such as:
- Syncope, dizziness, shortness of breath
- Chest discomfort, palpitations
- Abnormal test results that indicate the need for extended monitoring
- Underlying cardiac disease history
Also, ensure that your documentation includes the following:
- Patient’s name and presenting diagnosis
- Transmission time, date, and channel
- Abnormal intervals (PR, QRS when applicable)
- Heart rate and rhythm
- Patient-reported symptoms or lack thereof
- Staff actions taken (physician notifications, emergency instructions)
Verify the Medicare Reimbursement Rate
The reimbursement amount for CPT code 93225 is heavily dependent on the Medicare Administrative Contractor (MAC) locality, facility settings, and the appended modifiers.
According to the latest Medicare reimbursement rates, the national average reimbursement amount for 93225 for non-facility settings is $17.47.
You can check the Medicare reimbursement amount for your MAC locality via the PFS Lookup Tool.
Take Into Account the IDTF Considerations
If your practice operates as an independent diagnostic testing facility (IDTF), additional requirements apply. According to CMS guidelines, IDTFs can bill the total component but must have contracts with interpreting physicians.
The physician’s name and credentials must be on file with the WPS Provider Enrollment Department, and documentation should include a letter from the physician assigning payment rights for the professional codes to the IDTF.
Wrapping Up
Finally, we have reached the end of this guide. Let’s do a quick recap of all the important points. CPT code 93225 is used to bill the technical part of an extended Holter study (telemetry). For proper reimbursement, you must append the appropriate modifiers and detailed documentation with your claims.
We hope that with the help of this guide, you can now successfully file claims for 93225. However, billing is not everyone’s cup of tea, and providers can face frequent denials even after taking all the precautions. The best solution is to acquire specialized cardiology billing services via outsourced billing partners like MediBillMD.
