Does 93292 require prior authorization?

No, 93292 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 93292?

Medicare facility rate: $51.44. Non-facility rate: $51.44. Work RVU: 0.42.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.42

Facility

$51.44

Non-Facility

$51.44

The patient's medical record must document relevant medical history, physical exam, and results of pertinent diagnostic tests or procedures supporting medical necessity for the interrogation service.
Maintain date(s) of device implant, device identification, a copy of the physician's order for the service, all transmissions, formal interpretations/reports, and the reason for the service (routine follow-up versus specific symptoms).
If the service is for symptoms, document the nature of the symptoms; if Internet-based remote service is used, retain a signed service agreement between manufacturer and physician if required.
The interpreting physician must personally review/analyze device data, generate and sign the report when billing the professional component; when the technical component is billed separately, documentation of supervision/interpretation is required.

Face-to-face interrogation is covered each time it is medically necessary and provided with documentation of medical necessity.
Remote interrogation is covered as a surveillance option beginning with initiation of remote monitoring or starting on the 91st day after ICD implantation.
ICD surveillance (face-to-face or remote) is covered to monitor device behavior or to investigate symptoms such as post-event shock, syncope/near-syncope, palpitations, suspected malfunction, or device failure.
Routine surveillance interrogation is covered for asymptomatic patients without device discharge (monitoring purpose), e.g., presence of ICD Z95.810.
Interrogation and reprogramming are covered to evaluate and adjust device settings including iterative testing to select optimal programmed parameters.
Peri-procedural evaluation/interrogation and programming before and/or after a surgical procedure or test is covered when necessary to modify or disable device function for the procedure (e.g., to avoid electrocautery interference or disable during cardiac surgery).

A53018 — Billing and Coding: Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based

J06

L33693 — Peripheral Venous Ultrasound

J09

L34833 — Cardiac Rhythm Device Evaluation

J12

A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)

J12

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