Electrophysiology procedures are some of the most complex and high-value services in cardiovascular medicine. Each insurance claim can bring in hundreds of dollars for your practice, or you might lose this amount if you don’t file your claims properly.
CPT code 93656 is among the most prominent electrophysiology codes. Keeping in mind its importance and the frequent errors that billers make while filing the claims, we have prepared this detailed guide on code 93656.
By the end of this guide, you will have all the information you need to secure reimbursement for this vital procedure. So, let’s start.
CPT Code 93656 – Description
CPT code 93656 is defined as:
“Intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation (PVI)”
Or more comprehensively as:
“A comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia, including left or right atrial pacing/recording, and intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation (PVI).”
Sounds hard? Let’s explain this in simple terms.
93656 is a cardiovascular electrophysiology code. It is used to treat atrial fibrillation. The procedure is performed using a technique called pulmonary vein isolation (PVI). During the procedure, the cardiologist punctures a small hole in the wall separating the heart chamber to insert electrodes and assess or measure electrical activity. He then uses a cardiac ablation procedure to create a ring of scar tissue around the pulmonary veins. This last step is known as PVI. By isolating the pulmonary veins, the cardiologist creates a barrier for the abnormal electrical signals, which are the source of atrial fibrillation.
CPT code 93656 relates to a very comprehensive procedure. Naturally, it includes many bundled sub-services that are not separately reimbursable. The following are some services bundled with 93656:
- Intracardiac electrophysiologic 3D mapping (CPT 93613)
- Intracardiac echocardiography (CPT 93662)
- Transseptal catheterization
- Left atrial pacing and recording (CPT 93621)
- Right ventricular pacing and recording
- His bundle recording
Scenarios Where CPT Code 93656 is Applicable
CPT code 93656 can be used to treat many types of atrial fibrillation. To make things easier for you, we have discussed two real scenarios in which it can be used:
Symptomatic Atrial Fibrillation
Let’s suppose that a man aged 55-60 years visits his cardiologist. He tells the physician that he is experiencing persistent palpitations, chest discomfort, and shortness of breath during daily activities. He also shares that these episodes occur multiple times a week, and he is seriously concerned about his well-being. Upon examination and electrocardiogram testing, the physician diagnoses symptomatic persistent atrial fibrillation.
As a first measure, the cardiologist prescribes some medicines. However, they remain ineffective and cause intolerable side effects. So, the physician suggests performing a catheter ablation with pulmonary vein isolation. After performing the surgery successfully, he bills the procedure with CPT code 93656.
Athletes with Atrial Fibrillation
Suppose a competitive marathon runner aged 35-40 years comes to a cardiologist after experiencing irregular heartbeats during training sessions. He regularly performs high-volume endurance training, logging over 50 metabolic equivalent-hours per week in preparation for upcoming competitions.
During the evaluation, continuous cardiac monitoring reveals episodes of atrial fibrillation, even during periods when the athlete feels asymptomatic. As a treatment, the physician suggests and performs a catheter ablation via pulmonary vein isolation. In this case, the procedure can be billed via CPT code 93656.
Applicable Modifiers for CPT Code 93656
To clarify the circumstances in which the surgery was performed, you can use the following modifiers:
| Modifier | What It Means | When To Use It |
|---|---|---|
| 22 | Increased Procedural Services | This modifier indicates that the work done to provide a service was much greater than typically required. |
| 53 | Discontinued Procedure | Used by physicians when the procedure is discontinued. |
| 59 | Distinct Procedural Service | Used when the procedure is performed with other procedures that are not typically reported together. |
| 73 | Discontinued Procedure Before Anesthesia | Used by hospitals or ambulatory surgery centers when the procedure is discontinued before anesthesia administration. |
| 74 | Discontinued Procedure After Anesthesia | Used by hospitals or ambulatory surgery centers when the procedure is discontinued after anesthesia administration. |
CPT Code 93656 – Billing & Reimbursement Guidelines
Don’t want to see another denial for intracardiac catheter ablation? Just keep in mind the following important points:
Medicare Reimbursement Rates
Medicare currently pays around $896.64 nationally for CPT code 93656 in facility settings, according to the 2025 Physician Fee Schedule.
However, this amount is the national average, and the actual payment varies for each MAC locality. You can check the exact reimbursement rate for your MAC locality via the PFS Lookup Tool.
Documentation Requirement
Catheter ablation via pulmonary vein isolation is a comprehensive procedure and holds a high reimbursement amount. So, insurance payers, including Medicare, require detailed documentation for proper reimbursement. We suggest that you provide the following details with your code 96356 claims:
- Evidence of symptoms attributable to atrial fibrillation (palpitations, chest pain, dyspnea, fatigue)
- Documentation of antiarrhythmic drug trials, contraindications, or intolerance
- Objective evidence of atrial fibrillation burden through electrocardiographic monitoring
- Assessment of stroke risk and anticoagulation status
- Evaluation of ventricular function and structural heart disease
Wrapping Up
CPT code 93656 is used to bill a sophisticated electrophysiology procedure. This procedure aims to treat atrial fibrillation. You must provide thorough documentation with your claims and append the necessary modifiers when needed.
However, if you are facing claim denials even after following the guidelines, you might need professional help. Our experts at MediBillMD offer specialized cardiology billing services guaranteed to reduce your denial rates.
