CPT Code 93000 (2023) | Description, Guidelines, Reimbursement, Modifiers & Examples

93000 CPT code will be billed for service when the patient is being monitored to record the heart’s electrical activity by applying multiple electrodes to the patient’s chest. These electrodes are joined with ECG machines by lead wires. Heart activity will be interpreted, measured, and printed on the page. Impulses will show how fast blood flows, heart rhythms, strength, and timing of impulses from one part to another part of the heart.

93000 CPT Code | Description & Explanation

93000 CPT code service includes both technical and professional components, while if only a technical component is done, then CPT 93005 will be reported and CPT 93010 for the professional part only.  

The official description of CPT code 93000 is: “Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report”.

Electrocardiogram (CPT 93000) (EKG or ECG) is usually performed to monitor heart rate, conduction, and rhythm.

The following list contains reasons to perform an EKG: 

• For the evaluation of irregular heartbeats.
• To find the reason for chest pain.  
• To identify the issues related to the heart, such as shortness of breath, unbearable chest pain, dizziness, or fainting. 
• To check the embedded. 
• To check if pacemakers are working correctly or not  
• Pre and post-evaluation of the heart before any surgery or procedures or other heart conditions like Myocardial infarction, endocarditis, severe heart attack  
• To determine whether Medicine is working effectively or not. 
• To trace any abnormal findings during the physical exam. 

The following conditions and factors will influence CPT 93000 results: accumulation of fluid in the body, obesity, drugs before the test, pregnancy, smoking, size and locations of the heart, and chemical imbalance in the body such as magnesium, potassium, and calcium. 

CPT 93000 will be reported when a physician performs a routine Electrocardiogram (ECG), which includes:

• At least 12 leads
• Performed With Interpretation and report

Reimbursement

A maximum of 3 units of 93000 CPT code can be billed on the same service date. Modifier 26 or TC are not applicable with CPT 93000.

The reimbursement for CPT 93000 includes the cost and RUVS are as follows:

Facility: Cost $16.04, RUVS 0.46355

Non-Facility: Cost $16.04, RUVS 0.46355

Modifiers

Modifier 25 will be appended with Evaluation and Management (E/M) CPT codes when performed in conjunction with CPT 93000 on the same day.

For example, the patient presented to the office for intermittent chest pain for three days. The physician prescribed some medicines and ordered an EKG to confirm any heart-related issues.

Therefore, It would be billed as CPT 93000 without any modifier, and the E/M CPT code will be billed with modifier 25.

While modifier 59 is appropriate to bill with CPT 9300 as the NCCI bundle exists for this CPT with E/M or check with payer-specific guidelines if the modifier is needed.

Modifier 26 is used to bill the professional component and TC for the Technical component. Both these components are included in the CPT 93000. Therefore, there is no need to append modifier 26 or TC with CPT 93000

Modifier 52 will be used when 93000 CPT code service is performed, limited what usually perform.

If EKG (CPT 93000) is repeated on the same day by the same physician, it is appropriate to add a modifier 76. In contrast, modifier 77 will be applicable when a different physician does EKG CPT 93000 on the same day.

Billing Guidelines

CPT 93000 service includes separate medical written and signed reports, order of service, and documentation that should support this service and medical necessity.

If Echocardiography (CPT 93303 – 93350) is performed in combination with CPT 93000, then CPT codes (93303-93350) are separately reportable without modifier requirements as per NCCI.

IF CPT 93000 is performed in conjunction with the Intracardiac ischemia monitoring system (CPT codes (0525T-0532T), then modifier 59 will be added with CPT 93000 and allowed to be billed together on the same date of service.

If acoustic cardiography (93799) is performed with EKG 93000 CPT code, it should be spritely reportable without any modifier.

If only the professional component is used, it is appropriate to report CPT code 93010 instead of the 93000 CPT code, while for the technical detail, you should bill only the CPT code 993005. CPT 93000 will be billed globally without any TC and 26 modifiers.

A separate ECG code (93042) exists for 1-3 Leads, while CPT 93000 is for at least 12 leads. If both services are performed on the same day, modifier 59 will be appended with the CPT 93000.

If CPT codes 93000 services is performed in the Emergency department (CPT code 99281-99285) or Critical care codes (99291, 99292), then the only interpretation of an ECG report (CPT 93010) will be considered as part of E/M. Otherwise, It will be billed separately.

IF CPT 93000 is performed with any surgical procedure, regardless of whether it is a minor or major procedure, it is not a separately payable service. It will only be payable when it is done for an unrelated condition.

Billing Examples

The following are five billing examples of when the 93000 CPT code should be billed.

Example 1

A 38-year-old male presents with a primary complaint of dizziness. The patient reports vertigo began one day ago. Vertigo began while at home when he stood up. The patient describes the course of vertigo as abrupt and is currently 6/10.

Vertigo is worsened by standing, head movement, and movement. It is not further exacerbated by breathing or lying supine. He states that anti-vertigo meds alleviate the dizziness.

The vertigo is associated with nausea, vomiting, and gait instability, not vision change.

The patient is morbidly obese has a higher risk of heart disease. The physician ordered multiple diagnostic tests ECG, CMP, CBC CT, MRI, and X-ray of the head and spine.

Billing:

CPT Codes:

• CPT 99203: Office or other outpatient visit for the evaluation and management of a new patient: This code is used for the initial evaluation of the patient’s vertigo and associated symptoms.
• CPT 93000: Electrocardiogram, routine ECG with at least 12 leads: This diagnostic test is ordered to assess the patient’s heart function due to the higher risk of heart diseases.
• CPT 80053: Comprehensive metabolic panel (CMP): This diagnostic test is ordered to evaluate the patient’s overall metabolic health.
• CPT 85025: Complete blood count (CBC): This diagnostic test is ordered to assess the patient’s overall blood cell counts and health.
• CPT 70450: Computed tomography, head; without contrast material: This diagnostic test is ordered to visualize any potential issues within the patient’s head that may be causing vertigo.
• CPT 72141: Magnetic resonance (e.g., MRI), cervical spine; without contrast material: This diagnostic test is ordered to evaluate the patient’s cervical spine, which may be contributing to the vertigo.
• CPT 72040: Radiologic examination, spine, cervical; 2 or 3 views: This diagnostic test is ordered to further assess the patient’s cervical spine.

ICD-10 Codes:

• ICD-10 R42: Dizziness and giddiness: This code documents the patient’s primary complaint of dizziness.
• ICD-10 R11.0: Nausea: This code is used to document the patient’s associated symptom of nausea.
• ICD-10 R11.2: Vomiting, unspecified: This code is used to document the patient’s associated symptom of vomiting.
• ICD-10 R26.81: Unsteadiness on feet: This code is used to document the patient’s gait instability.
• ICD-10 E66.01: Morbid (severe) obesity due to excess calories: This code documents the patient’s morbid obesity and the associated higher risk of heart disease.

Example 2

A 30-year-old female with no PMH is coming in for intermittent episodes of chest pain that are somewhat exacerbated by left-arm movement but are non-exertional.

Differential includes, but is not limited to MSK-related pain/costochondritis/ ACS Pt is very well appearing with standard physical exam and vitals.

She is not having any pain right now. Given the positional nature of chest pain, I suspect musculoskeletal cause. The patient was not getting better by medication. Physicians ordered a CT chest and EKG to confirm that the heart was functioning correctly. 

Billing:

CPT Codes:

• CPT 99203: Office or other outpatient visit for the evaluation and management of a new patient: This code is used for the patient’s initial visit to address her intermittent chest pain.
• CPT 71260: Computed tomography, thorax; with contrast material(s): This code is used for the CT chest ordered by the physician to assess the cause of the patient’s chest pain.
• CPT 93000: Electrocardiogram, routine ECG with at least 12 leads: This code is used for the EKG ordered by the physician to evaluate the patient’s heart function.

ICD-10 Codes:

• ICD-10 R07.89: Other chest pain: This code is used to document the patient’s chief complaint of intermittent chest pain.
• ICD-10 M79.1: Myalgia: This code documents the suspected musculoskeletal cause of the patient’s chest pain.

Example 3

Forty-six-year-old female with PMH of hypertension and a family history of heart disease heart murmur, LBBB dx 1 year ago, migraines, tested positive for COVID 1 month ago.

The patient is not vaccinated for COVID. Since yesterday afternoon, she was presented to ED c/o constant lip-tingling, lightheadedness, and left-sided chest discomfort.

She woke this morning with the same symptoms, and also developed left upper extremity tingling and bilateral hand tingling.

She denies headache, shortness of breath, back pain, abdominal pain, nausea, vomiting, diarrhea, changes in vision, urinary complaints, or other symptoms.

The patient has a strong family history of heart disease. The physician plans to do labs, EKG, X-ray, CT, and chest MRI.

Billing:

CPT Codes:

• CPT 99222: Initial hospital care, per day, for the evaluation and management of a patient (includes the review of systems and examination): This code is used for the initial assessment of the patient’s condition and management plan in the hospital setting.
• CPT 93000: Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report: This diagnostic test is ordered to evaluate the patient’s left-sided chest discomfort and LBBB.
• CPT 71020: Radiologic examination, chest, 2 views, frontal and lateral: This diagnostic test is ordered to assess the patient’s chest and rule out any potential issues related to COVID.
• CPT 70450: Computed tomography, head or brain; without contrast material: This diagnostic test is ordered to assess the patient’s lip-tingling and lightheadedness.
• CPT 71550: Magnetic resonance (e.g., MRI), chest (including mediastinum), without contrast material: This diagnostic test is ordered to further evaluate the patient’s chest discomfort and potential heart issues.

ICD-10 Codes:

• ICD 10 I10: Essential (primary) hypertension: This code is used to document the patient’s history of hypertension.
• ICD 10 I25.10: Atherosclerotic heart disease of native coronary artery without angina pectoris: This code is used to document the patient’s family history of heart disease.
• ICD 10 R94.31: Abnormal electrocardiogram [ECG] [EKG]: This code is used to document the patient’s LBBB diagnosis.
• ICD 10 G43.909: Migraine, unspecified, not intractable, without status migrainosus: This code is used to document the patient’s history of migraines.
• ICD 10 U07.1: COVID-19: This code is used to document the patient’s recent positive COVID test result.
• ICD 10 R29.0: Tetany: This code is used to document the patient’s tingling symptoms in lips and extremities.
• ICD 10 R42: Dizziness and giddiness: This code is used to document the patient’s lightheadedness.
• ICD 10 R07.1: Chest pain, unspecified: This code documents the patient’s left-sided chest discomfort.

Example 4

A 27-year-old male with PMH Systolic/Diastolic CHF (EF <15% 7/23/21, s/p AICD), COVID x2, s/p TAVR, CAD, CKD, PAD, hypothyroidism for shortness of breath.

He has developed progressively worsening shortness of breath for four days. He noticed worsening SOB lying on his right side and with exertion.

He takes his vitals daily and weighs himself daily; he typically weighs 171lbs but has seen a 3.5lb increase to 174.5lbs over this past week which prompted him to take one dose of alprazolam 30mg. He noticed a minimal improvement in his symptoms with the alprazolam.

He has also noticed increasing yellow phlegm production, cough, nasal congestion, and rhinorrhea. When he has episodes of coughing with phlegm, he sees a substernal discomfort.

The discomfort is not alleviated with rest and not exacerbated with exertion. The physician has respiratory problems along with Heart issues. The physician ordered EKG, Labs, CT, and MRI to diagnose further treatment.

Billing:

CPT Codes:

• CPT 99223: Initial hospital care, per day, for the evaluation and management of a patient (includes the review of systems and examination): This code is used for the patient’s presentation with shortness of breath and associated symptoms.
• CPT 93000: Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report: This code is used for the EKG ordered by the physician to evaluate the patient’s heart issues.
• CPT 71045: Radiologic examination, chest; single view: This code is used for the chest X-ray ordered to assess the patient’s respiratory problems.
• CPT 70450: Computed tomography, head or brain; without contrast material: This code is used for the CT ordered by the physician to evaluate the patient’s condition further.
• CPT 72141: Magnetic resonance (e.g., MRI), cervical spine; without contrast material: This code is used for the MRI ordered by the physician to evaluate the patient’s condition further.

ICD-10 Codes:

• ICD 10 I50.23: Systolic (congestive) heart failure: This code is used to document the patient’s history of systolic/diastolic CHF.
• ICD 10 U07.1: COVID-19: This code is used to document the patient’s history of COVID infection.
• ICD 10 Z95.810: Presence of automatic (implantable) cardiac defibrillator: This code is used to document the patient’s history of AICD implantation.
• ICD 10 I35.0: Aortic (valve) stenosis: This code is used to document the patient’s history of aortic valve stenosis and TAVR procedure.
• ICD 10 I25.10: Atherosclerotic heart disease of native coronary artery without angina pectoris: This code is used to document the patient’s history of CAD.
• ICD 10 N18.9: Chronic kidney disease, unspecified: This code is used to document the patient’s history of CKD.
• ICD 10 I70.90: Generalized atherosclerosis, unspecified: This code is used to document the patient’s history of PAD.
• ICD 10 E03.9: Hypothyroidism, unspecified: This code is used to document the patient’s history of hypothyroidism.
• ICD 10 R06.02: Shortness of breath: This code is used to document the patient’s chief complaint of shortness of breath.
• ICD 10 R09.02: Hypoxemia: This code documents the patient’s low oxygen levels related to their respiratory problems.

Example 5

A 39-year-old female presented to the office for dizziness, weakness, and tingling in the upper extremity. The patient denies any abdominal pain, diarrhea, vomiting, or headache in the review of the system.

A physical exam revealed that the patient had an irregular heartbeat, shortness of breath, and fluid accumulation in the upper extremity, more likely edema.

Physical exam strongly suggests ruling out heart-related diseases. The physician decides to do an ECG/EKG, CTA, and MRA of the chest. EKG revealed that the patient was a tachycardiac.

The physician consulted with a cardiologist for further treatment of the patient. 

Billing:

CPT Codes:

• CPT 99203: Office or other outpatient visit for the evaluation and management of a new patient: This code is used for the initial assessment of the patient’s symptoms and management plan.
• CPT 93000: Electrocardiogram, routine ECG with at least 12 leads: This code is used to represent the ECG/EKG performed to evaluate the patient’s irregular heartbeat and tachycardia.
• CPT 71275: Computed tomographic angiography, chest (noncoronary): This code represents the chest CTA performed to evaluate the patient’s heart-related issues.
• CPT 71555: Magnetic resonance angiography, chest (excluding myocardium): This code is used to represent the MRA of the chest performed to further evaluate the patient’s heart-related issues.

ICD-10 Codes:

• ICD-10 R42: Dizziness and giddiness: This code documents the patient’s dizziness complaint.
• ICD-10 R53.1: Weakness: This code is used to document the patient’s complaint of weakness.
• ICD-10 R20.2: Paresthesia of the skin: This code documents the patient’s tingling in the upper extremity.
• ICD-10 I49.8: Other specified cardiac arrhythmias: This code documents the patient’s irregular heartbeat and tachycardia.
• ICD-10 R06.02: Shortness of breath: This code documents the patient’s shortness of breath.
• ICD-10 R60.9: Edema, unspecified: This code documents the patient’s fluid accumulation in the upper extremity.