Highmark Medicare Services

12102, 12202, 12302, 12501, 12301, 12201

MAC Part A & B

A47804

Article

No

Surveillance of Implantable Cardioverter-Defibrillator (ICD), Office, Internet or Non-Internet Based

A47804

Pennsylvania, Maryland, District of Columbia, DELAWARE

07/11/2008

08/01/2008

N/A

Coding Guidelines

The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This information does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

The Internet based monitoring should only be billed using code 93741 or 93743 (with modifiers as appropriate). These codes describe monitoring without reprogramming.

The date of service for the Internet based monitoring is reported as the date of the retrieval of the data from the central server by the physician. 

The face-to-face monitoring may be billed using code 93741, 93742, 93743 or 93744 (with modifiers as appropriate). These codes describe monitoring with or without reprogramming.

The technical component of the service is reported by appending the –TC modifier to the appropriate monitoring service procedure code.

The professional component of the service is reported by appending the –26 modifier to the appropriate monitoring service procedure code.

Upon completion of an Internet based monitoring analysis, it may be determined that the device needs to be reprogrammed.  It is appropriate to report a reduced service (code 93742 or 93144) utilizing the –52 modifier for a limited interrogation and incomplete analysis performed at the same time as a reprogramming.

The date of the retrieval of the data from the central server by the physician will be considered the date of service for the Internet based modality. The number of units of service is always reported as one (1) regardless of the number of patient transmissions to the server.

The name and NPI of the referring/ordering physician or qualified non-physician practitioner are required on the CMS 1500 form or the electronic equivalent. 

Payable places of service are as follows:

• 93741, 93741TC, 93742, 93742TC, 93743, 93743TC, 93744 and 93744TC are payable in the office (11) and independent clinic (49).
• 93741(26) and 93743(26) are payable in the inpatient hospital (21) for a face-to-face service only.
• 93741(26) and 93743(26) are payable in the office (11), outpatient hospital (22) and independent clinic (49) for a face-to-face or an Internet based service.
• 93742(26) and 93744(26) are payable in the office (11), inpatient hospital (21), outpatient hospital (22) and independent clinic (49) for a face-to-face service only.

If a significantly separate and identifiable face-to-face service, requiring the billing of an E&M service, is provided at the same time as the interrogation of the ICD or review of the downloaded data, the E&M service should be coded using a -25 modifier.

Diagnostic Tests and X-Rays

Refer to LCD L27533 for more information on surveillance of implantable cardioverter-defibrillator (ICD), office, Internet or Non-Internet based.

Refer to CMS Internet Online Manual Publication 100-3, Chapter 1, Section 20.8 through 20.8.1.1 for coverage of cardiac pacemaker monitoring.

A47804