Does 93799 require prior authorization?

No, 93799 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for 93799?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Diagnostic test claims must include the test result if known; if result is not available, report the symptoms that prompted the test.
The patient medical record must include the ordering provider's assessment related to the patient's complaint, relevant medical history, and results of pertinent tests/procedures.
Office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.

Coverage and billing for cardiac event detection should follow the clinical indications and medical necessity criteria specified in Local Coverage Determination L34573.
Cardiac event detection (CED) is covered to detect, characterize, and document symptomatic transient (paroxysmal) arrhythmias when symptoms are infrequent and a 24-hour ambulatory EKG is unlikely to capture the arrhythmia.
CED is covered to regulate antiarrhythmic drug dosage when monitoring is needed to assess medication efficacy.
CED is covered to monitor patients who have had surgical or ablative procedures for arrhythmias.
Covered CED devices must be non-insertable (non-implanted), patient- or event-activated, intermittently record arrhythmic events, and provide either a presymptom memory loop or post-symptom recording.
Covered when symptom frequency is limited or in asymptomatic patients at risk for clinically significant arrhythmias and a longer monitoring period is more likely to capture, characterize, or document transient/paroxysmal arrhythmias than a 24-hour ambulatory EKG.

A56452 — Billing and Coding: Cardiac Event Detection

A56606 — Billing and Coding: Cardiac Event Detection

L34573 — Cardiac Event Detection

L33952 — Cardiac Event Detection

UHC-POL-implantable-recorders-wearable-monitors — Implantable Loop Recorders and Wearable Heart Rhythm Monitors

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