Future Retirement Local Coverage Article Billing and Coding

Billing and Coding: Real-Time, Outpatient Cardiac Telemetry


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Contractor Information

Article Information

General Information

Article ID
Article Title
Billing and Coding: Real-Time, Outpatient Cardiac Telemetry
Article Type
Billing and Coding
Original Effective Date
Revision Effective Date
Revision Ending Date
Retirement Date
ANTICIPATED 06/11/2023
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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L34997, Real-Time, Outpatient Cardiac Telemetry. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Procedure codes 93228 and 93229 are reported once per 30 day monitoring period. The date of service is reported on the claim as the date the monitoring period is initiated (i.e., the date the patient is first placed on the monitor).

Technical services (93229) that are transferred from one receiving center to another during the same monitoring period must be reported with the modifier -52. Each entity that provided a portion of the technical portion must report 93229 with the -52 modifier and indicate in the claim narrative the percentage of the total service provided.

Claims for outpatient cardiac telemetry (wearable mobile cardiovascular telemetry) with concurrent real-time data analysis and NOT greater than 24 hours of accessible ECG storage, such as the eCardio eVolution monitor, should not be billed under these codes.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Coding Information


Group 1

(2 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
93228 Remote 30 day ecg rev/report
93229 Remote 30 day ecg tech supp

CPT/HCPCS Modifiers


ICD-10-CM Codes that Support Medical Necessity

Group 1

(31 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 93228 and 93229.

Group 1 Codes
G45.9 Transient cerebral ischemic attack, unspecified
I44.0 Atrioventricular block, first degree
I44.1 Atrioventricular block, second degree
I44.2 Atrioventricular block, complete
I44.30 Unspecified atrioventricular block
I45.6 Pre-excitation syndrome
I45.89 Other specified conduction disorders
I47.0 Re-entry ventricular arrhythmia
I47.1 Supraventricular tachycardia
I47.21 Torsades de pointes
I47.29 Other ventricular tachycardia
I47.9 Paroxysmal tachycardia, unspecified
I48.0 Paroxysmal atrial fibrillation
I48.11 Longstanding persistent atrial fibrillation
I48.19 Other persistent atrial fibrillation
I48.20 Chronic atrial fibrillation, unspecified
I48.21 Permanent atrial fibrillation
I48.3 Typical atrial flutter
I48.4 Atypical atrial flutter
I48.91 Unspecified atrial fibrillation
I48.92 Unspecified atrial flutter
I49.2 Junctional premature depolarization
I49.5 Sick sinus syndrome
I67.841 Reversible cerebrovascular vasoconstriction syndrome
I67.848 Other cerebrovascular vasospasm and vasoconstriction
R00.0 Tachycardia, unspecified
R00.1 Bradycardia, unspecified
R00.2 Palpitations
R42 Dizziness and giddiness
R55 Syncope and collapse
Z79.01* Long term (current) use of anticoagulants
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Report Z79.01 in conjunction with I48.0, I48.20, I48.21 or I48.91 to indicate monitoring to determine appropriateness of anticoagulation therapy discontinuation.

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the "ICD-10 Codes that Support Medical Necessity" section of this policy.

Group 1 Codes
XX000 Not Applicable

ICD-10-PCS Codes


Additional ICD-10 Information


Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

999x Not Applicable

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

99999 Not Applicable

Other Coding Information


Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2022 R2

Article revised and published on 10/20/2022 effective for dates of service on and after 10/01/2022 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM codes have been added to the Article: I47.21 and I47.29 to the ‘Group 1 Codes’ and the following ICD-10-CM code has been deleted and therefore has been removed from the article: I47.2 from ‘Group 1 Codes’. In addition, the reference to the Social Security Act has been added to the ‘CMS National overage Policy’ section and Documentation requirements have been added. Formatting changes have been made throughout the article.

10/01/2019 R1

LCD revised and published on 10/17/2019 effective for dates of service on or after 10/01/2019. Consistent with CMS Change Request 10901, all coding information from the related LCD has been placed into this article. The statement regarding monitoring services such as eCardio eVolution has been removed from the LCD and placed in the article. Standard language has been added throughout the article. In response to the Annual ICD-10-CM update, the following ICD-10-CM codes have been deleted and therefore have been removed from the article: I48.1 and I48.2. The following ICD-10-CM codes have been added to the article: I48.11, I48.19, I48.20 and I48.21 and the asterisk explanation has been updated. Due to system changes, the Coding Section has been reordered and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

Associated Documents

Related Local Coverage Documents
L34997 - Real-Time, Outpatient Cardiac Telemetry
Related National Coverage Documents
Statutory Requirements URLs
Rules and Regulations URLs
CMS Manual Explanations URLs
Other URLs
Public Versions
Updated On Effective Dates Status
10/14/2022 10/01/2022 - N/A Currently in Effect You are here
10/11/2019 10/01/2019 - 09/30/2022 Superseded View
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