CPT 93654: Comprehensive EP Evaluation With Ventricular Tachycardia Ablation

CPT 93654 covers a comprehensive electrophysiology study with ablation of ventricular tachycardia or a focus of ventricular ectopy. Its descriptor carries every inclusion of 93653 and adds left ventricular pacing and recording, which makes the add-on lines that get attached to it easy to predict and easy to prevent.

What CPT 93654 covers

93654 continues the 93653 descriptor, so it includes the same comprehensive evaluation with 3-dimensional mapping, right ventricular pacing and recording, left atrial pacing and recording and His bundle recording, when performed, and adds treatment of ventricular tachycardia or a focus of ventricular ectopy including left ventricular pacing and recording, when performed.

What the comprehensive ablation codes already include

93653, 93654 and 93656 are comprehensive codes: each wraps the diagnostic electrophysiology study and the ablation into one report. Since the CPT 2022 revision, their descriptors also absorb several services that used to be billed alongside them.

• All three include insertion and repositioning of multiple electrode catheters, induction or attempted induction of the arrhythmia, intracardiac electrophysiologic 3-dimensional mapping, right ventricular pacing and recording, and His bundle recording, when performed.
• 93653 and 93654 also include left atrial pacing and recording from the coronary sinus or left atrium. 93654 also includes left ventricular pacing and recording.
• 93656 also includes transseptal catheterizations and intracardiac echocardiography with imaging supervision and interpretation.

The separate codes for those services are therefore not reported with these three: 93613 (3D mapping), 93621 (left atrial pacing), 93622 (left ventricular pacing, with 93654) and, with 93656, 93662 (ICE) and 93462 (transseptal puncture). The single-site EP studies (93600 to 93603, 93610, 93612, 93618) and the comprehensive studies 93619 and 93620 are included as well. Only one primary ablation code is reported per session.

Add-on codes that may accompany an ablation

• 93655: ablation of a discrete arrhythmia mechanism distinct from the primary mechanism, including repeat diagnostic maneuvers, in the same session.
• 93657: additional linear or focal ablation of the left or right atrium for atrial fibrillation remaining after pulmonary vein isolation is complete. It belongs with 93656.
• 93662: intracardiac echocardiography, with 93653 and 93654 when performed and documented. Not with 93656, which includes it.
• 93462: transseptal puncture, where performed with 93653 or 93654. Not with 93656, which includes it. Hospital outpatient payment for it is packaged, so check how your setting reports it.

Add-on codes never carry modifier 51 and never stand alone without their primary code on the claim.

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

• 93654 with 93613: 3D mapping is included. This pairing denies.
• 93654 with 93621 or 93622: left atrial and left ventricular pacing and recording are included.
• 93654 with a separate diagnostic EP study: included in the comprehensive code.
• 93654 with 93653 or 93656: mutually exclusive.
• 93654 with 93655 or 93662: separately reportable where documented.

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 93656. EP study with AF ablation by pulmonary vein isolation.
• CPT 93650. AV node ablation.

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.