Holter Monitor CPT Code (2023) | Descriptions, Guidelines, Reimbursement, Modifiers & Examples

Holter monitor CPT code(s) 93224-93227 are for services when the physician performs an external electrocardiographic—recording for up to 48 hours by continuous rhythm recording and storage, comprising recording and scanning analysis.

This study evaluates the full-day cycle of a patient’s ambient heart rhythm. The physician suggests the patient use an external electrocardiographic (ECG) recorder, a Holter monitor. 

The technician places ECG leads on the patient’s chest, and the patient wears the recorder for up to 48 hours. During this time, there is continuous rhythm recording and storage.

The patient returns the device, and a technician plays the recorded heart rhythm back into digital format.

The technician uses scanning to classify different ECG waveforms and generate a report. The generated report describes the overall rhythm and significant arrhythmias.

Code 93225 reports the recording only, including connection, data recording, and disconnection. Code 93226 bills only the scanning analysis with the report. Code 93227 claims only the provider review and interpretation.

Holter Monitor CPT Code Description 

CPT 93224 bills for service when the PhysicianPhysician performs external electrocardiographic recording for up to 48 hours by continuous rhythm recording and storage, comprising complete analysis and recording, report, review, and interpretation by a physician.

CPT 93225 bills for service when the PhysicianPhysician performs external electrocardiographic recording for up to 48 hours by continuous rhythm recording and storage, comprising of connection, recording, and disconnection

CPT 93226 bills for service when the PhysicianPhysician performs external electrocardiographic recording for up to 48 hours by continuous rhythm recording and storage, comprising of scanning analysis with report

CPT 93227 bills for service when the PhysicianPhysician performs external electrocardiographic recording for up to 48 hours by continuous rhythm recording and storage, comprising of review and interpretation by a physician or other qualified health care professional

Reimbursement

A maximum of one unit can be a bill on the same service date of the CPT codes for Holter Monitor. In contrast, the two units allow when documentation supports the medical necessity of the service. 

The cost and RUVS of CPT 93224 are $88.53 and 2.55818 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 93224 are $88.53 and 2.55818 when performed in the non-facility.

The cost and RUVS of CPT 93225 are $23.03 and 0.66557 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 93225 are $23.03 and 0.66557 when performed in the non-facility.

The cost and RUVS of CPT 93226 are $45.40 and 1.31182 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 93226 are $45.40 and 1.31182 when performed in the non-facility.

The cost and RUVS of CPT 93227 are $20.10 and 0.58079 when performed in the facility. In contrast, the reimbursement and RUVS of CPT93227 are $20.10 and 0.58079 when performed in the non-facility.

Holter Monitor CPT Code Modifiers

Modifier 76 is applicable with the Holter Monitor CPT codes when a similar service performs by the Same Physician on the same service date.

Modifier 76 is applicable with CPT 93224-93227 when a similar service performs by a different Physician on the same service date.

Modifier 59 is applicable with CPT 93224-93227 when a Distinct service performs by the PhysicianPhysician and bundled with another procedure on the same date.  

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 93224-93227 when service bills to medicare insurance. It divides Modifier into four different parts for further specification of the procedure.

Modifier 53 will be reported with CPT 93224-93227 if unsuccessful Holter monitors are due to unavoidable circumstances like allergic reactions to the substance.

 Modifier 22 applies to CPT 93224-93227 when services perform longer than usual and take extra resources during the procedure.

Modifier 23 is applicable with CPT 93224-93227 when general or local anesthesia administers by the PhysicianPhysician and routinely does not require it during the procedure.

Modifier 52 applies when the PhysicianPhysician does not complete the Holter monitor hours and service terminates due to unavoidable circumstances.

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 93224-93227 must apply the GA modifier to that service.

Holter Monitor CPT Code Billing & Coding Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate. 

CPT 93224-93227 includes in-person and remote cardiac monitoring for electrocardiographic data assessment. Up to 48 hours of recording continuously

Echocardiography CPT codes (93303-93355, 93356) reports separately in combination with CPT code 93224-93227.

Implantable patient-activated cardiac event recorders (93285, 93291, 93297-93298) appropriates to report separately in conjunction with CPT code 93224-93227.

If cardiac monitoring is beyond 48 hours, it is appropriate to report these CPT codes (93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248) instead of CPT 93224-93227. 

Modifier 52 is appropriate with CPT code 93224-93227 when Holter monitoring lasts less than 12 hours. 

Billing Examples

The following are examples of when Holter Monitor CPT codes should be billed.

Example 1

A 38-year-old male presents to ED with a chief 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. The dizziness is currently 6/10. Vertigo is worsened by standing, head movement, and movement. The vertigo is not worsened by breathing or lying supine. 

Anti-vertigo meds alleviate vertigo. Vertigo is associated with nausea, vomiting, and gait instability. Vertigo is not associated with a vision change.

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

Diagnostic studies show that patient had an irregular heartbeat and suggested a Holter monitor for two days. 

Example 2

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

Differential includes, but is not limited to, MSK-related pain/costochondritis/ ACS Pt is very well appearing with routine physical exam and vitals. She is not having any pain right now. Given the positional nature of chest pain, I suspect a musculoskeletal cause. 

The patient was not getting better by medication. Physicians ordered a chest CT and EKG to confirm that the heart was functioning correctly. 

Diagnostic studies show that the patient had an irregular heartbeat and suggested a Holter monitor for 24 hours. 

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. 

Since yesterday afternoon, she was presented to ED c/o constant lip-tingling, lightheadedness, and left-sided chest discomfort. She woke morning with the same symptoms and developed left upper extremity tingling and bilateral hand tingling. The patient is not vaccinated for COVID. 

The patient Denies headache, shortness of breath, back pain, abdominal pain, nausea, vomiting, diarrhea, changes in vision, urinary complaints, or any other symptoms. 

The patient has a family history of heart diseases—the physician plan to do labs, EKG, X-ray, CT, and chest MRI.

Diagnostic studies show that the patient had an irregular heartbeat and suggested a Holter monitor for 24 hours.

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 171 lbs but has seen a 3.5lb increase to 174.5 lbs over this past week, prompting him to take one dose of alprazolam 30mg.

He noticed a minimal improvement in his symptoms with the alprazolam. 

When he has episodes of coughing with phlegm, he notices a substernal discomfort. The discomfort is not alleviated with rest and not exacerbated with exertion. He has also noticed increasing yellow phlegm production, cough, nasal congestion, and rhinorrhea. 

The PhysicianPhysician has respiratory problems along with Heart issues. Diagnostic studies show that the patient had an irregular heartbeat and suggested a Holter monitor for 24 hours.

The PhysicianPhysician ordered EKG, Labs, CT, and MRI to diagnose for further treatment.

Example 5

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

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

A 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 is tachycardic. Diagnostic studies show that the patient had an irregular heartbeat and suggested a Holter monitor for 24 hours. The physician consulted with the cardiologist for further treatment of the patient.