Does 93228 require prior authorization?

No, 93228 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 93228?

Medicare facility rate: $25.05. Non-facility rate: $25.05. Work RVU: 0.47.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.47

Facility

$25.05

Non-Facility

$25.05

Claims for cardiac event detection require the documentation, coding, and billing information consistent with LCD L34573; this article provides complementary billing and coding guidelines.
Progress notes must document medical necessity for the EKG monitoring service.
List the diagnosis code(s) indicating the reason for the test on the claim.
The physician interpreting the test must be identified on the claim form with his/her sequence number in Box 24K.

Coverage and billing for cardiac event detection should follow the clinical indications and medical necessity criteria specified in Local Coverage Determination L34573.
Holter monitoring (CPT 93224-93227) is covered for up to 48 hours of continuous recording when progress notes document medical necessity.
Wearable external mobile cardiac telemetry (CPT 93228 professional, 93229 technical) is covered as one unit per course of treatment that includes up to 30 consecutive days of cardiac monitoring when the documented services (hook-up, transmission, analysis, daily reports, equipment and supplies, and physician review) are provided.
Long-term continuous recorders (CPT 93241-93248) that continuously record and store for greater than 48 hours up to 7 days, or greater than 7 days up to 15 days, are covered in the outpatient setting when documentation supports medical necessity.
An IDTF must be credentialed and approved by Palmetto GBA provider enrollment to bill Medicare for a specific diagnostic procedure or material.
Additional services and supplies (e.g., radiopharmaceuticals, special contrast agents, medications) are payable to an IDTF when the diagnostic test itself is payable and the supplies are commonly separately reimbursed to a physician in an office setting.

A57476 — Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

J05

L34636 — Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

J05

L39492 — Ambulatory Electrocardiograph (AECG) Monitoring

J09

A59270 — Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring

J09

Ask Verity about documentation requirements, denial risks, or coverage in your state.