Electrocardiographic Monitoring Services Billing

Overlapping electrocardiographic monitoring denial questions are among the top inquiries received in the Provider Contact Center (PCC).

Providers should contact the referring/ordering provider to determine what service was ordered to ensure proper billing. Electrocardiographic monitoring codes must be billed in sets and sets cannot be completed within 29 days of each other. These codes, per the Current Procedural Terminology (CPT) coding book, are provided in the table below.

Service Technical CPT Professional CPT Hook up CPT Global CPT
Ambulatory Cardiac Telemetry (ACT) 93229 93228 Included in 93229 NA
Cardiac Event Monitoring (CEM) 93271 93272 93270 93268
Holter 93226 93227 93225 93224

 

The claims processing system reviews all Part A and B claims nationwide for billing overlaps. There are no appeal rights for these denials. If a provider needs assistance in identifying which code caused the denial and the overlapping provider/group, contact the Part B PCC.

See the CMS National Coverage Determination (NCD) for Electrocardiographic Services (20.15) for coverage guidelines to determine medical necessity.

Last Updated Tue, 21 Aug 2018 16:23:16 +0000