Does 93243 require prior authorization?

No, 93243 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 93243?

Medicare facility rate: $244.83. Non-facility rate: $244.83. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

$244.83

Non-Facility

$244.83

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.
If an IDTF bills the total component, the physician's name and address must be on file with the WPS Provider Enrollment Department and the physician must provide a letter assigning monies collected for professional codes to the IDTF.

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.
A supervising physician for an IDTF must be licensed in the state(s) where tests are performed, enrolled in Medicare, not excluded, meet proficiency standards for tests supervised, and provide general supervision for no more than three IDTF sites.

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

J05

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

J05

L39492 — Ambulatory Electrocardiograph (AECG) Monitoring

J09

L33693 — Peripheral Venous Ultrasound

J09

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