Office and outpatient E&M codes (99202-99215) are selected by MDM or time under 2021 revised rules. History and physical exam no longer drive level selection though remain clinically necessary.
- 99213: established patient, low to moderate complexity, 20-29 minutes
- 99214: established patient, moderate complexity, 30-39 minutes
- 99215: established patient, high complexity, 40-54 minutes
- 99203-99205: new patient equivalents (30-74 minute ranges)
Cardiology imaging codes
ECG
- 93000 — complete ECG (global). 2026 Medicare national fee approximately $15.36.
- 93005 — technical component only (tracing).
- 93010 — professional component only (interpretation).
Echocardiography
- 93306 — complete TTE with spectral and color Doppler. 2026 Medicare global fee approximately $220-$230.
- 93307 — complete TTE without Doppler.
- 93308 — follow-up or limited TTE.
- 93350 — stress echocardiography.
- 93351 — stress echo with continuous ECG monitoring.
Stress testing
- 93015 — cardiovascular stress test with supervision, interpretation, and report.
- 93016 — supervision only.
- 93017 — tracing only.
- 93018 — interpretation and report only.
Nuclear cardiology
- 78452 — myocardial perfusion SPECT, multiple studies (rest and stress).
- 78454 — SPECT, single study.
- A9500 — technetium Tc-99m sestamibi, per study dose.
- A9502 — technetium Tc-99m tetrofosmin, per study dose.
- J0152 / J1245 / J0153 — pharmacologic stress agents (adenosine / dipyridamole / regadenoson).
Catheterization and intervention
Diagnostic left heart catheterization
- 93454 — coronary angiography only.
- 93455 — with bypass graft angiography.
- 93456 — with right heart catheterization.
- 93457 — with right heart cath and bypass graft.
- 93458 — with LV angiography. 2026 Medicare ASC national payment approximately $1,707.76 for the base 93454.
- 93459 — with LV angiography and bypass graft.
- 93460 — with right heart cath and LV angiography.
- 93461 — with right heart cath, LV angiography, and bypass graft.
Select the single most-inclusive code that describes what was performed. Billing 93454 alongside 93458 generates CO-97 bundling denial.
PCI
- 92928 — PCI with stent, single major coronary artery or branch.
- 92929 — each additional branch (add-on to 92928).
- 92933-92944 — PCI variants (bypass graft, atherectomy, chronic total occlusion, acute MI).
Cardiac device implantation
- 33206 — single-chamber ventricular pacemaker.
- 33207 — single-chamber atrial pacemaker.
- 33208 — dual-chamber pacemaker. 2026 Medicare national physician fee approximately $456. Requires modifier KX per NCD.
- 33249 — ICD implantation.
- 33224 — LV lead placement for CRT (at time of implant).
- 33225 — LV lead placement for CRT (with new device implant).
Device interrogation
- 93288 — in-person pacemaker interrogation.
- 93289 — in-person ICD interrogation.
- 93293 — pacemaker transtelephonic evaluation.
- 93294 — pacemaker remote monitoring, up to 90 days.
- 93295 — ICD remote monitoring, up to 90 days.
- 93296 — remote programming.
Remote patient monitoring (non-device)
- 99453 — initial setup and education for RPM device use.
- 99454 — device supply with data transmission, per 30 days.
- 99457 — RPM treatment management, first 20 minutes per calendar month.
- 99458 — each additional 20 minutes per calendar month.
Modifier quick reference
- 25 — significant, separately identifiable E&M on same day as procedure. Applied to E&M code.
- 26 — professional component only.
- TC — technical component only.
- 59 — distinct procedural service (X modifiers: XE, XP, XS, XU offer more specificity).
- 78 — unplanned return to OR for related procedure during global period.
- 79 — unrelated procedure during global period.
- 24 — unrelated E&M during postoperative period.
- KX — physician certifies coverage criteria met (required on pacemaker claims per NCD).
- 95 — synchronous telemedicine (audio-video).
- 93 — synchronous telemedicine (audio-only).
Global period reference
- 0-day: diagnostic imaging (echo, stress, cath, ECG). Follow-up billed separately.
- 90-day: cardiac device implantation (33206-33249), PCI (92928-92943). Routine postop care included in initial payment.
MAC jurisdiction quick lookup
- Novitas: CO, NM, OK, TX, AR, LA, MS, DE, DC, MD, NJ, PA
- First Coast: FL, PR, USVI
- Palmetto GBA: NC, SC, VA, WV, JJ/JM contract areas
- WPS: IL, IN, IA, KS, MI, MN, MO, NE, WI
- Noridian: AK, AZ, CA, HI, ID, MT, NV, ND, OR, SD, UT, WA, WY
- CGS: KY, OH
- NGS: CT, ME, MA, NH, NY, RI, VT
Each MAC publishes cardiology LCDs at cms.gov/medicare-coverage-database.
Denial rate benchmarks (MGMA 2024)
- All specialties average: 10-12% initial denial rate
- Cardiology industry average: 15-20%
- MGMA acceptable threshold: 8%
- Top-performing cardiology: under 5%
- Best-in-class: under 3%
Common denial patterns and defenses
CO-97 bundling denial (cath codes)
Cause: billing a component code alongside its parent (93454 with 93458). Defense: select the single most-inclusive code from the cath report specificity.
CO-50 medical necessity denial (echo, stress)
Cause: ICD-10 code not on the MAC's LCD covered-indications list, or repeat study within frequency window without clinical trigger. Defense: LCD-mapped documentation with covered ICD-10 and clinical-trigger notes.
CO-4 modifier missing (device implantation)
Cause: pacemaker claim submitted without modifier KX. Defense: KX modifier on every 33206, 33207, 33208 claim without exception.
CO-16 information missing (any code)
Cause: required documentation, authorization, or referral missing from claim submission. Defense: pre-submission scrub against payer-specific requirements.
Modifier 25 audit downgrade
Cause: E&M billed with modifier 25 without documentation showing distinct significant separately identifiable service beyond the procedure's inherent evaluation. Defense: distinct E&M documentation addressing separate problem or decision-making not captured in the procedure.
Audit posture
Cardiology audit focus areas (OIG, CMS TPE, RACs): E&M level upcoding, echocardiography medical necessity and frequency, elective PCI for stable ischemic heart disease, cardiac device implantation appropriateness, modifier misuse. Internal audit of a 10-25 claim monthly sample identifies documentation gaps before external audit exposure develops.
Sources for updates
- CMS Medicare Coverage Database (LCDs and NCDs)
- CMS Physician Fee Schedule (annual updates, quarterly interim)
- NCCI edits (quarterly updates)
- CPT (annual updates from AMA)
- HCPCS (annual updates from CMS)
- MAC-specific email subscription lists (real-time LCD notification)