CPT 93650: Intracardiac Catheter Ablation of the Atrioventricular Node

CPT 93650 covers deliberate ablation of atrioventricular conduction to create complete heart block, the ablate-and-pace strategy. It sits apart from the comprehensive ablation codes, and the confusion around it is mostly about what else can be billed on the same day.

What CPT 93650 covers

93650 is intracardiac catheter ablation of atrioventricular node function and atrioventricular conduction for the creation of complete heart block, with or without temporary pacemaker placement.

Unlike 93653, 93654 and 93656, this is not a comprehensive code wrapped around a diagnostic study. It describes a targeted ablation with a specific intent: to interrupt conduction in a patient who will be pacemaker dependent.

Reimbursement context

Electrophysiology procedures are high-value and heavily documented, and the difference between a correctly and incorrectly coded ablation session is large enough to matter on a single case.

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 arrhythmia being treated, named specifically, with its mechanism.
• Catheters inserted and their positions.
• Induction or attempted induction, and the response.
• Pacing and recording performed at each site, noted even where the code includes it.
• The ablation target, energy delivered and endpoint achieved.
• Where a second distinct mechanism was treated, its identification as distinct from the primary.
• Mapping and imaging performed, named specifically so the record shows what the comprehensive code covered.
• A signed procedure note naming the study and ablation performed.

Common denials and the exact fix

Modifier rules

• 51: never appended to the ablation add-on codes, which are exempt from multiple-procedure reduction.
• 59 / XE / XP / XS / XU: reserved for genuinely distinct services. Not a route to reporting mapping, pacing or a diagnostic EP study that the comprehensive code already includes.
• 26 / TC: applies in facility settings where professional and technical components are billed separately.
• 22: increased procedural services, requiring a narrative and manual review.
• 53: discontinued procedure, where an ablation was aborted after the patient was prepared.
• 78 / 79: return to the procedure room during a global period, related or unrelated.

NCCI bundling edits

• 93650 with temporary pacemaker placement: included in the descriptor.
• 93650 with 93653, 93654 or 93656: these describe different procedures; report what was actually performed.
• Permanent device implantation: a separate service with its own code when performed in the same session.
• Vascular access, guidance and closure are included.
• 93650 is assigned to a lower-level electrophysiology APC than the comprehensive ablation codes when performed alone, which is a facility payment matter rather than a coding edit.

Frequently asked questions

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 93653. EP study with SVT ablation.
• CPT 93624. EP follow-up study.
• CPT 93656. EP study with AF ablation by pulmonary vein isolation.

Related reading

• Cardiology billing & RCM. How we scrub cardiology claims across diagnostics, cath lab, EP and remote monitoring.
• Cardiac cath billing: NCCI bundling and modifier 59. Where cath lab bundling edits bite, and when a distinct-service modifier is genuinely earned.
• TC/26 modifier errors in cardiology. The split-billing mistakes that cost diagnostic practices the most.