93228 CPT code is a crucial billing code in 2025 for reporting external mobile cardiac telemetry services in the United States. This code represents the physician’s professional component (interpretation) of a long-term wearable heart monitor, often prescribed to capture elusive cardiac arrhythmias over an extended period. In 2025, staying updated on CPT 93228 guidelines is vital: new coding changes and payer rules have emerged that affect reimbursement. This comprehensive guide explains what CPT 93228 covers, outlines the latest 2025 updates, and provides practical billing tips for medical billers, coders, and healthcare providers.
Understanding CPT 93228: Mobile Cardiac Telemetry Overview
Mobile cardiac telemetry (MCT) is a form of long-term wearable electrocardiographic monitoring (WEM) – a diagnostic procedure that records a patient’s heart rhythm during daily activities. CPT 93228 specifically describes the physician review and interpretation of data from an external mobile cardiovascular telemetry device, covering up to 30 days of continuous ECG monitoring.
This code is used when a doctor analyzes the ECG recordings and prepares a report for a 30-day telemetry monitoring episode. Meanwhile, its counterpart CPT 93229 represents the technical component – the setup, equipment provision, patient education, and 24/7 surveillance provided by the monitoring service center.
Mobile telemetry devices continuously record the heart’s electrical activity and automatically transmit abnormal rhythm events or patient-activated recordings to a remote monitoring center. These centers provide real-time surveillance and alert physicians if serious arrhythmias occur. Because MCT can detect rare or sporadic events, it’s often preferred for patients with unexplained symptoms or cryptogenic stroke.
2025 Updates and Changes for CPT 93228
What’s new in 2025? While the code description for CPT 93228 remains unchanged, several contextual changes have occurred. The CPT code set now includes additional ECG monitoring codes, such as 93241–93248 and Category III codes 0937T–0940T, which cover similar services but differ in duration and monitoring style.
Additionally, the Medicare Physician Fee Schedule (MPFS) for 2025 introduced minor reimbursement adjustments. Local Coverage Determinations (LCDs) were also updated by Medicare Administrative Contractors (MACs) to reinforce the rule: CPT 93228 and 93229 should only be billed once per 30-day monitoring period.
Billing Guidelines for CPT 93228 in 2025
- One unit per 30 days: Bill 93228 only once per 30-day monitoring cycle, regardless of event quantity.
- Date of service (DOS): Use the monitoring start date, not the interpretation date.
- No modifier 26 or TC: These modifiers are not required and should not be used with 93228 or 93229.
- Avoid unbundling: Do not report 93228 alongside 93224, 93227, or other overlapping ECG monitoring codes.
- Bill 93228 and 93229 together (if applicable): When both interpretation and technical services are provided, submit both codes.
- Avoid overlapping billing: Do not bill a second 93228 before the previous 30-day cycle is complete.
Medical Necessity and Payer Requirements in 2025
Medicare and private payers require clear justification for mobile cardiac telemetry. For Medicare, acceptable indications include:
- Syncope, dizziness, or palpitations
- Unexplained stroke or TIA
- Suspected arrhythmias not captured on short-term monitors
Many commercial insurers (like Anthem and UHC) require that the patient first try shorter-duration monitors before qualifying for MCT. Prior authorization is often required, and specific ICD-10 codes must support the medical necessity. Always check payer-specific rules before billing.
Documentation and Coding Tips
To support CPT 93228:
- Include detailed physician interpretation with the monitoring period’s start and end dates.
- Document symptoms, failed prior testing, and the reason for extended monitoring.
- Include diagnosis codes that align with medical necessity.
- Ensure device education, patient consent, and 24/7 surveillance are part of the record (for 93229).
Tip: If billing to Medicare and the service may be denied, issue an ABN (Advance Beneficiary Notice) and append modifier GA or GZ as appropriate.
Common Denials and How to Avoid Them
- Duplicate billing: Don’t submit multiple 93228 claims for the same 30-day span.
- Incorrect code usage: Ensure the service type matches the correct CPT (Holter vs MCT vs event recorder).
- Missing documentation: Provide a thorough narrative and physician interpretation.
- Incorrect DOS: Use the monitoring start date to avoid claim rejections.
FAQ: CPT 93228 Billing
How often can CPT 93228 be billed?
Once per 30-day monitoring period. A new claim should only be submitted after the current cycle is complete.
Do I need modifiers with 93228 or 93229?
No. These codes are inherently professional (93228) and technical (93229). Modifiers 26 or TC are not applicable.
What diagnoses support 93228?
Common ICD-10 codes include R55 (syncope), R42 (dizziness), I47.1 (supraventricular tachycardia), and Z86.73 (history of stroke).
Conclusion
93228 CPT code remains vital for billing physician interpretation of mobile cardiac telemetry in 2025. To get reimbursed accurately, follow payer-specific rules, ensure proper documentation, and bill only once per monitoring episode. For more help on related coding, explore our guides on 93268 CPT code, claim denial codes, or get tips on ICD-10 coding.