CPT 93295 covers the physician analysis, review and report for remote monitoring of an implantable defibrillator system across a period of up to 90 days. It is the defibrillator counterpart to 93294, and mixing the two up is a routine source of denials.
What CPT 93295 covers
93295 is remote interrogation device evaluation of a single, dual or multiple lead implantable defibrillator system, up to 90 days, with interim physician analysis, review(s) and report(s).
It is the professional component for a defibrillator. The technical work is reported with 93296, which covers both pacemaker and defibrillator systems.
How the remote device monitoring family is organised
Pacemakers and defibrillators use a professional code and a technical code. Implantable monitors changed for Medicare in 2024, so read the last three lines carefully.
- 93294: pacemaker system, remote, physician analysis, review and report. Up to 90 days.
- 93295: implantable defibrillator system, remote, physician analysis, review and report. Up to 90 days.
- 93296: pacemaker or defibrillator system, remote, technical. Data acquisition, receipt of transmissions, technician review, technical support and distribution of results. Up to 90 days.
- 93297: implantable cardiovascular physiologic monitor, remote evaluation. Up to 30 days.
- 93298: subcutaneous cardiac rhythm monitor, including implantable loop recorders, remote evaluation. Up to 30 days.
- 93299: CPT's technical-only code for those two monitor types. Medicare does not use it. CMS created G2066 for the technical component in 2020, deleted G2066 for 2024, and accepted the practice-expense inputs on 93297 and 93298 instead. For Medicare the technical component is reported with modifier TC on 93297 or 93298.
Not the same as remote physiologic monitoring
These codes are frequently confused with the remote physiologic monitoring family (99453, 99454, 99457 and 99458), which covers monitoring of physiologic parameters such as weight, blood pressure and pulse oximetry using a supplied device.
They are different services with different rules, different time periods and different documentation. A cardiac implantable device being monitored remotely belongs in the 93294 to 93299 family. Billing it under the RPM codes, or the reverse, produces denials that look mysterious until the families are separated.
Reimbursement context
Remote monitoring is a recurring revenue stream rather than a one-off procedure, so the economics depend on billing every eligible period exactly once.
Medicare pays for this code under the Physician Fee Schedule, and the amount depends on where you practise. Each code carries relative value units for physician work, practice expense and malpractice, each adjusted by a geographic practice cost index (GPCI) for the locality, and the total is multiplied by the conversion factor:
(work RVU × work GPCI + practice expense RVU × PE GPCI + malpractice RVU × MP GPCI) × conversion factor
For 2026 the conversion factor is $33.4009 for practitioners who are not qualifying APM participants and $33.5675 for qualifying APM participants, as set in the CY 2026 Physician Fee Schedule final rule (CMS-1832-F; see the CMS fact sheet). Because the RVUs differ by code and the GPCIs differ by locality, what your practice is paid will differ from any national average. Pull the RVUs and the payment for your own locality from the CMS Physician Fee Schedule Look-Up Tool.
Documentation requirements
- The device type and model, and the date of implant.
- At least one transmission received and reviewed within the 90-day period.
- The dates the monitoring period began and ended.
- The data elements reviewed, not merely that a transmission arrived.
- A dated, signed report of the analysis and any clinical action taken, where the professional component is billed.
- Evidence of the technical infrastructure and technician review, where the technical component is billed.
- Confirmation that the period has not already been billed for this patient and device.
Common denials and the exact fix
Reported more than once in the same period
The most common denial in this family. The code covers the whole monitoring period, so a second claim inside it is a duplicate no matter how many transmissions arrived.
Fix: track the period start date per patient and per device, and let the billing system rather than the calendar month drive the claim.
No transmission received in the period
A period with no transmission does not support the code, even where the equipment was in place and the patient was enrolled.
Fix: confirm at least one transmission was received and reviewed before billing, and work the non-transmitting patient list as an operational task rather than a billing one.
Wrong device code selected
93294 is for pacemaker systems and 93295 for defibrillator systems. A defibrillator billed under the pacemaker code under-reports the service, and the reverse over-reports it.
Fix: drive code selection from the device record rather than from a default in the billing template.
Billed on a 30-day cycle
Defibrillator remote monitoring runs on a 90-day period.
Fix: bill once per 90 days. The 30-day cycle belongs to the implantable monitor codes.
Therapy events reviewed but not documented
Defibrillator monitoring frequently surfaces arrhythmia episodes and delivered therapies. Reviewing them without recording the findings weakens the claim.
Fix: record the episodes reviewed, the therapies delivered and any programming change in the signed report.
Modifier rules
- 93294, 93295, 93296: no 26 or TC. The professional and technical work is split through separate codes, so appending a component modifier is redundant and can cause a rejection.
- 93297, 93298: for Medicare, modifier 26 (professional) and TC (technical) apply when two entities provide the two parts. Billed globally, with no modifier, when one entity provides both.
- 59 / XE / XP / XS / XU: rarely applicable, and never a route to reporting the same monitoring period twice.
- 25: on an E/M where a separately identifiable visit occurred, never on the monitoring code.
- GY / GA: where a service is statutorily excluded or an advance beneficiary notice is on file, per payer instruction.
NCCI bundling edits
- 93295 with 93296: separately reportable as professional and technical components.
- 93295 with 93294: report the code matching the device, not both.
- 93295 reported twice in one 90-day period: duplicate.
- 93295 with the remote physiologic monitoring codes: different family.
Frequently asked questions
What is the difference between CPT 93294 and 93295?
How often can 93295 be billed?
What should the report contain for a defibrillator?
Sources
American Medical Association, CPT 2026 Professional Edition.
Centers for Medicare & Medicaid Services, National Correct Coding Initiative Policy Manual and quarterly edit tables, cms.gov.
Centers for Medicare & Medicaid Services, Physician Fee Schedule Look-Up Tool, cms.gov.
American College of Cardiology, acc.org. AAPC coding resources, aapc.com.
CPT® is a registered trademark of the American Medical Association. Code descriptors are summarised here for billing guidance and are not a substitute for the current CPT codebook. Payer rules and NCCI edits change quarterly; verify against your own payer policy before submission.
Related codes
- CPT 93294. Remote pacemaker check, physician component.
- CPT 93296. Remote pacemaker or ICD check, technical component.
- CPT 93298. Remote subcutaneous rhythm monitor, 30 days.
Related reading
- Cardiology billing & RCM. How we scrub cardiology claims across diagnostics, cath lab, EP and remote monitoring.
- Cardiac RPM billing compliance. Transmission windows, documentation and the rules that trip up remote monitoring claims.
- TC/26 modifier errors in cardiology. The split-billing mistakes that cost diagnostic practices the most.
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