Stress test CPT code, CPT 93016, cpt code 93016, 93016 cpt code, CPT 93017, cpt code 93017, 93017 cpt code, CPT 93018, cpt code 93018, 93018 cpt code

Cardiovascular Stress Test CPT Codes | Description, Guidelines, Reimbursement, Modifiers & Examples

Cardiovascular stress test CPT codes 93015 – 93018 can be billed for services when physicians perform cardiovascular stress tests using techniques such as the maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, or Pharmacological stress. It may serve with or without supervision and interpretation.

The following are the reasons why a physician performs a stress test:

  • It aids in identifying heart-related diseases
  • Congestive heart failure 
  • Heart valve disease
  • Congenital heart disease
  • Hypertrophic cardiomyopathy and coronary artery disease
  • Angina
  • Shortness of breath (dyspnea)
  • Arrhythmia
  • Dizziness or Lightheadedness

Physician supervised heart stress test. The test monitors the heart rhythm by electrocardiogram (ECG or EKG) during exercise (treadmill or bicycle). Drugs are administered to the patient to stimulate stress.

The physician continuously records the heart’s electrical activity acquired by an assistant supervised by a qualified health care professional. It aids in monitoring the stress on the heart.

Cardiovascular Stress Test CPT code 93015

Stress Test CPT code 93015 includes all the supervision, interpretation, and test. In contrast, Stress Test CPT code(s) 93016, 93017, and 93018 include management of the test, performing of test only, and understanding of priorly performed test, respectively. 

nuclear stress test cpt code

CPT 93015 bills for service when physicians perform Cardiovascular stress tests using different techniques such as: 

  • The maximal or submaximal treadmill or bicycle exercise
  • The physician continuously monitors the electrocardiographs, including pharmacological stress. 
  • It includes supervision interpretation and report.

The official description of CPT 93015 is: “Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report.”

Cardiovascular Stress Test CPT code 93016

Stress test CPT code 93016 bills for service when physicians perform cardiovascular stress tests using different techniques, such as

  • maximal or submaximal treadmill or bicycle exercise;
  • with continuous electrocardiographic monitoring and or pharmacological stress
  • with supervision only; and
  • without interpretation and report.
cpt code for stress test

The official description of CPT 93016 is: “Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; supervision only, without interpretation and report.”

Cardiovascular Stress Test CPT code 93017

CPT code 93017 is another stress test and can be used for service when physicians perform cardiovascular stress tests using;

  • different techniques such as the maximal or submaximal treadmill or bicycle exercise;
  • continuous electrocardiographic monitoring and or pharmacological stress;
  • with tracing only; and without
  • interpretation and report.
exercise stress test cpt code

The official description of CPT 93017 is: “Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report.”

Cardiovascular Stress Test CPT code 93018

CPT code 93018 is the last stress test and can be billed for service when physicians perform cardiovascular stress tests by using;

  • different techniques such as the maximal or submaximal treadmill or bicycle exercise;
  • including continuous electrocardiographic monitoring and or pharmacological; stress;
  • it includes supervision only,
  • it includes tracing only, and
  • this stress test includes interpretation and reports only.
93018

The official description of CPT 93018 is: “Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; interpretation and report only.”

Billing Guidelines and Reimbursement For The Cardiovascular Stress Test CPT Codes

A maximum of one unit can be a bill on the same Stress Test CPT code(s) 93015-93018 service date. In contrast, the three units allow documentation supporting the service’s medical necessity. 

The cost and RUVS of CPT 93015 are $80.96 and 2.33960 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 93015 are $80.96 and 2.33960 when performed in the non-facility.

The cost and RUVS of CPT 93016 are $23.35 and 0.67474 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 93015 are $23.35 and 0.67474 when performed in the non-facility.

The cost and RUVS of CPT 93017 are $42.00 and 1.21364 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 93015 are $42.00 and 1.21364 when performed in the non-facility.

The cost and RUVS of CPT 93018 are $15.62 and 0.45122 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 93015 are $15.62 and 0.45122 when performed in the non-facility.

Some physical therapists specializing in the area of cardiopulmonary care administer maximum graded exercise tests, rehabilitate acutely ill patients in the intensive care unit, design exercise programs to restore endurance and function for patients with organ transplants, and enable patients with acute and chronic heart or lung problems to resume functional activities. 

Some programs require a team of specialists (e.g., cardiac rehabilitation, pulmonary rehabilitation). The patient may be seen for more than an hour a day, progressing in multiple intervention programs, including exercise, bronchopulmonary hygiene, and education concerning cardiovascular fitness.

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

Physical therapists should report 97110 based on the treatment outcome for muscle strengthening.

Medical records include all the relevant information, conditions, and complexities that may impact the treatment. The description might consist of, for example, the premorbid function, date of onset, and current function. 

Examples

Below are five billing examples for the CPT codes for cardiovascular stress tests.

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, and 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 and has 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 the patient had an irregular heartbeat and suggested Cardiac perfusion with the stress test.

Billing:

CPT Codes:

  • CPT 99284: Emergency department visit for the evaluation and management of a patient with detailed history and examination: This code is used for the patient’s presentation to the ED with dizziness and vertigo.
  • CPT 93000: Electrocardiogram, routine ECG with at least 12 leads: This diagnostic test is ordered to assess the patient’s irregular heartbeat.
  • 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 health.
  • CPT 70450: Computed tomography, head; without contrast material: This diagnostic test is ordered to evaluate the patient’s head for any potential issues 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 for any potential issues causing vertigo.
  • CPT 72040: Radiologic examination, spine, cervical; 2 or 3 views: This diagnostic test is ordered to assess the patient’s cervical spine with X-ray imaging.
  • CPT 93015: Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, interpretation and report: This code is used if the stress test is performed with physician supervision, interpretation, and report.

ICD-10 Codes:

  • ICD 10 R42: Dizziness and giddiness: This code documents the patient’s chief complaint of dizziness and vertigo.
  • ICD 10 R11.0: Nausea: This code documents the patient’s associated symptoms of nausea.
  • ICD 10 R11.2: Vomiting, unspecified: This code is used to document the patient’s associated symptoms of vomiting.
  • ICD 10 R26.81: Unsteadiness on feet: This code documents the patient’s associated symptom of gait instability.
  • ICD 10 E66.01: Morbid (severe) obesity due to excess calories: This code documents the patient’s morbid obesity, which puts him at a higher risk of heart disease.
  • ICD 10 I49.8: Other specified cardiac arrhythmias: This code documents the patient’s irregular heartbeat detected in the diagnostic tests.

Example 2

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

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

The patient was not getting better with 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 Cardiac perfusion with the stress test.

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 presentation with intermittent chest pain.
  • CPT 71260: Computed tomography, thorax; with contrast material(s): This diagnostic test is ordered to evaluate the patient’s chest for any potential issues causing the chest pain.
  • CPT 93000: Electrocardiogram, routine ECG with at least 12 leads: This diagnostic test is ordered to assess the patient’s irregular heartbeat.
  • CPT 93015: Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, interpretation and report: This code is used if the stress test is performed with physician supervision, interpretation, and report.

ICD-10 Codes:

  • ICD 10 R07.1: Chest pain on breathing: This code documents the patient’s chief complaint of intermittent chest pain exacerbated by left-arm movement.
  • ICD 10 M79.1: Myalgia: This code documents the suspected musculoskeletal cause of the chest pain.
  • ICD 10 R07.89: Other chest pain: This code documents the differential diagnosis of costochondritis or acute coronary syndrome.
  • ICD 10 I49.8: Other specified cardiac arrhythmias: This code documents the patient’s irregular heartbeat detected in the diagnostic tests.

Example 3

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

Since yesterday afternoon, she has presented to ED c/o constant lip-tingling, lightheadedness, and left-sided chest discomfort. She woke with the same symptoms and developed left upper extremity tingling and bilateral hand tingling. The patient did not get 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 Cardiac perfusion with the stress test.

Billing:

CPT Codes:

  • CPT 99284: Emergency department visit for the evaluation and management of a patient with detailed history and examination: This code is used for the patient’s presentation to the ED with lip-tingling, lightheadedness, and left-sided chest discomfort.
  • CPT 93000: Electrocardiogram, routine ECG with at least 12 leads: This diagnostic test is ordered to assess the patient’s irregular heartbeat.
  • CPT 71045: Radiologic examination, chest; single view: This diagnostic test is ordered to evaluate the patient’s chest for any potential issues.
  • CPT 70450: Computed tomography, head; without contrast material: This diagnostic test is ordered to evaluate the patient’s head for any potential issues causing the tingling sensation.
  • CPT 72141: Magnetic resonance (e.g., MRI), cervical spine; without contrast material: This diagnostic test is ordered to evaluate the patient’s cervical spine for any potential issues causing the tingling sensation.
  • CPT 93015: Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, interpretation and report: This code is used if the stress test is performed with physician supervision, interpretation, and report.

ICD-10 Codes:

  • ICD 10 I10: Essential (primary) hypertension: This code documents the patient’s history of hypertension.
  • ICD 10 Z86.79: Personal history of other diseases of the circulatory system: This code is used to document the patient’s family history of heart disease, heart murmur, and LBBB.
  • 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 documents the patient’s positive test result for COVID-19 a month ago.
  • ICD 10 R29.81: Tingling sensation (paresthesia): This code documents the patient’s chief complaint of lip-tingling and extremity tingling.
  • ICD 10 R42: Dizziness and giddiness: This code documents 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 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 patient has respiratory problems along with heart issues. Diagnostic studies show that the patient had an irregular heartbeat and suggested Cardiac perfusion with the stress test. The Physician ordered EKG, Labs, CT, and MRI to diagnose for further treatment.

Billing:

CPT Codes:

  • CPT 99214: Office or other outpatient visit for the evaluation and management of an established patient: This code is used for the patient’s visit addressing the shortness of breath and other symptoms.
  • CPT 93000: Electrocardiogram, routine ECG with at least 12 leads: This diagnostic test is ordered to assess the patient’s irregular heartbeat.
  • CPT 78451: Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic): This diagnostic test is ordered to evaluate the patient’s cardiac perfusion and to perform a stress test.
  • CPT 93015: Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report: This code is used for the stress test component of the myocardial perfusion imaging.
  • CPT 74177: Computed tomography, abdomen and pelvis; without contrast material: This diagnostic test is ordered to further assess the patient’s condition.
  • CPT 72148: Magnetic resonance (e.g., MRI), lumbar spine; without contrast material: This diagnostic test is ordered to evaluate potential spinal issues related to the patient’s symptoms.

ICD-10 Codes:

  • ICD-10 I50.23: Acute on chronic systolic (congestive) heart failure: This code documents the patient’s systolic/diastolic congestive heart failure history.
  • ICD-10 J12.82: Pneumonia due to coronavirus disease 2019 (COVID-19): This code documents the patient’s history of COVID-19 infection.
  • ICD-10 I35.0: Nonrheumatic aortic (valve) stenosis: This code documents the patient’s history of TAVR (transcatheter aortic valve replacement).
  • ICD-10 I25.10: Atherosclerotic heart disease of native coronary artery without angina pectoris: This code documents the patient’s history of coronary artery disease.
  • ICD-10 N18.9: Chronic kidney disease, unspecified: This code documents the patient’s history of chronic kidney disease.
  • ICD-10 I70.90: Generalized and unspecified atherosclerosis: This code documents the patient’s history of peripheral artery disease.
  • ICD-10 E03.9: Hypothyroidism, unspecified: This code documents the patient’s history of hypothyroidism.
  • ICD-10 R06.02: Shortness of breath: This code documents the patient’s chief complaint of shortness of breath.

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 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. 

Diagnostic studies show that the patient had an irregular heartbeat and suggested Cardiac perfusion with the stress test. EKG revealed that the patient is tachycardic. The physician consulted with the cardiologist for further treatment of the patient.

Billing:

CPT Codes:

  • CPT 99215: Office or other outpatient visit for the evaluation and management of an established patient: This code is used for the patient’s office visit to address her symptoms of dizziness, weakness, and tingling in the upper extremity.
  • CPT 93000: Electrocardiogram, routine ECG with at least 12 leads: This code is used for the ECG/EKG to evaluate the patient’s irregular heartbeat.
  • CPT 71275: Computed tomographic angiography, chest (noncoronary), with contrast material(s): This code is used for the CTA of the chest ordered to evaluate the patient’s heart condition further.
  • CPT 74185: Magnetic resonance angiography, chest (including bilateral upper extremity runoff): This code is used for the MRA of the chest ordered to assess the patient’s fluid accumulation in the upper extremity.
  • CPT 78452: Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first-pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection: This code is used for the cardiac perfusion with stress test ordered based on the diagnostic findings.

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 complaint of tingling in the upper extremity.
  • ICD-10 R00.1: Bradycardia, unspecified: This code documents the patient’s irregular heartbeat detected during the physical exam.
  • ICD-10 R06.02: Shortness of breath: This code documents the patient’s shortness of breath.
  • ICD-10 R60.0: Localized edema: This code documents the patient’s fluid accumulation in the upper extremity.

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