How to bill for EKG?
Asked by: Randi Kozey DVM | Last update: October 1, 2025Score: 4.6/5 (51 votes)
Does an EKG require a 25 modifier?
You should not use modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on an E/M code (such as 99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient) when ...
What is the 93000 billing guideline?
The 93000 CPT code serves a specific purpose in the healthcare industry. It allows for billing and reimbursement of a routine electrocardiogram (ECG) procedure with at least 12 leads, along with the interpretation and report provided by healthcare professionals.
What is the CPT code for EKG test?
Therefore, when an electrocardiogram (ECG), CPT code 93000, is billed in the office setting (POS 11) for a patient 18 years of age or older and the only diagnosis is a general medical exam diagnosis (ICD-10 diagnosis codes Z00.
What ICD-10 code will cover EKG?
Abnormal electrocardiogram [ECG] [EKG]
R94. 31 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2025 edition of ICD-10-CM R94. 31 became effective on October 1, 2024.
Medical Billing Guidelines — EKG and Medicare Billing
What is an EKG billed under?
Electrocardiogram (ECG or EKG) – CPT and ICD-10 Codes
If a physician performs only the interpretation and report (without the tracing), they should report CPT code 93010-not 93000 with modifier -26. DON'T apply it when another physician already interpreted the test.
Do you need modifier 25 with 93000?
You should append modifier -25 to the evaluation and management (E/M) code, but you should not need additional modifiers for 69210, “removal impacted cerumen (separate procedure), one or both ears,” or for 93000, “electrocardiogram, routine ECG with at least 12 leads; with interpretation and report,” because these ...
Does insurance cover EKG?
You can reduce the amount you pay for an EKG to less than $100 by getting insurance coverage. Most medical insurances cover 80-100% of ECG testing. Meaning, you'll only have to pay small amounts as copays with the cover, depending on the insurance plan you choose.
What is the HCPCS code for EKG?
HCPCS Code for Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination G0404.
Is ECG the same as EKG?
EKG and ECG are actually different spellings of the same diagnostic test that monitors your heart's electrical activity. EKG is the abbreviation from the German spelling of electrocardiogram (which is elektrokardiogramm in German).
When to bill 93000 vs 93010?
93000 is the complete procedure and includes ECG tracing with physician review, interpretation and report. Use 93005 to report the tracing only, and 93010 to report physician interpretation and written report only.
What is the ICD-10 code for cardiac monitoring?
2025 ICD-10-PCS Procedure Code 4A12X45: Monitoring of Cardiac Electrical Activity, Ambulatory, External Approach.
How often will Medicare pay for an EKG?
Electrocardiogram (EKG or ECG) screenings
Part B covers an EKG or ECG (as a one-time screening with a referral from your doctor as part of your "Welcome to Medicare" preventive visit and as a diagnostic test.)...
When should a 25 modifier be used?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
What is the modifier 76 for EKG?
Repeat Procedures by Same Physician
When the same physician interprets serial x-rays or EKGs performed on the same day, CPT modifier 76 must be submitted to indicate the service was repeated subsequent to the original procedure.
What should be included in the documentation of the EKG?
– Detailed Notes: Document any factors that might affect the EKG reading, such as patient movement, electrode placement, or any known conditions like electrolyte imbalances. This additional context is often crucial for the correct interpretation of the results.
How to bill an EKG?
According to CPT coding principles, a physician should select "the procedure or service that accurately identifies the service performed." CPT 93010 is defined as an "Electrocardiogram, routine ECG with at least 12-leads; interpretation and report only." CPT 93042 is defined as "Rhythm ECG, one to three leads; ...
What is the CPT for an EKG?
The ECG machine and tracings are considered the technical component of the 93005 service. 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only). Note: Report 93010 if your cardiologist performs only the interpretation and report of an ECG in a facility.
Does 93005 need a modifier?
Does CPT 93005 Need a Modifier? For CPT code 93005, which pertains to an electrocardiogram tracing, the following modifiers may be applicable: 1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed.
Is EKG covered as preventive care?
Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Can I request an EKG?
Some healthy patients request an EKG as a part of their regular checkups. An EKG isn't harmful to a patient, but it also isn't necessarily helpful.
What is the modifier for the CPT code 93000?
Does CPT 93000 Need a Modifier? For CPT code 93000, which pertains to a complete electrocardiogram, the following modifiers may be applicable: 1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed.
When to use modifier 24 examples?
Use Modifier 24 on an E/M when: An unrelated E/M service is performed beginning the day after the procedure, by the same physician, during the 10 or 90-day post-operative period. Documentation indicates the service was exclusively for treatment of the underlying condition and not for post-operative care.
When to use modifier 95?
-95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
How to tell if CPT codes are bundled?
This depends on medical coding rules. Bundling occurs when procedures or services with unique CPT or HCPCS Level II codes are billed together under one code. Unbundling is when two or more codes that are normally part of a single procedure can be billed separately.