CPT code 93295: Remote ICD check, defibrillator, professional review, up to 90 days2026 Medicare rate & RVUs in Detroit, MI
A physician or qualified clinician analyzes and reports remotely transmitted implantable defibrillator data for a monitoring period of up to 90 days.
In Detroit, MI, Medicare pays $36.86 for 93295 in the office and $36.86 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 93295 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 93295 covers
This service covers professional review of data that a patient's implantable cardioverter-defibrillator transmits from home through a bedside or wireless transmitter. A cardiologist, electrophysiologist, or other qualified clinician, such as a nurse practitioner or physician assistant, reviews device function and stored events. Findings may include battery status, lead impedance and sensing, arrhythmia episodes, shocks, and antitachycardia pacing. The clinician provides an interim analysis and report. Single-, dual-, and multiple-lead defibrillator systems, including cardiac resynchronization defibrillators, use this code.
Report 93295 once for a remote interrogation period of up to 90 days, rather than once per transmission. Documentation should support the device type, review of transmitted findings, and the clinician's analysis and report. CMS classifies 93295 as a professional-component-only code. Code 93296 separately describes remote data acquisition, receipt of transmissions, technician review, technical support, and distribution of results. An entity furnishing both services may report both codes when it meets each code's requirements. Remote pacemaker review uses 93294 instead; other implanted monitor types have separate remote review codes.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Detroit, MI compares for 93295
Across 109 of 109 payment localities, the office rate for 93295 runs from $33.80 in Arkansas to $48.02 in Alaska. Detroit, MI pays $36.86. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Detroit, MI · this page$36.86
- Rest of Michigan · Michigan$35.39−$1.47
- Los Angeles, CA · California$38.39+$1.53
- Washington, DC area · District of Columbia$39.40+$2.54
- Miami, FL · Florida$39.05+$2.19
- Chicago, IL · Illinois$38.46+$1.60
- Manhattan, NY · New York$40.27+$3.41
Other areas in Michigan first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlaskaAlaska | $48.02 | $48.02 |
| AlabamaAlabama | $34.05 | $34.05 |
| ArkansasArkansas | $33.80 | $33.80 |
| ArizonaArizona | $35.51 | $35.51 |
| Bakersfield, CACalifornia | $36.87 | $36.87 |
| Chico, CACalifornia | $36.70 | $36.70 |
| El Centro, CACalifornia | $36.71 | $36.71 |
| Fresno, CACalifornia | $36.70 | $36.70 |
| Hanford, CACalifornia | $36.70 | $36.70 |
| Madera, CACalifornia | $36.70 | $36.70 |
| Merced, CACalifornia | $36.70 | $36.70 |
| Modesto, CACalifornia | $36.70 | $36.70 |
| Napa, CACalifornia | $40.06 | $40.06 |
| Oxnard, CACalifornia | $38.00 | $38.00 |
| Redding, CACalifornia | $36.70 | $36.70 |
| Rest of CaliforniaCalifornia | $36.70 | $36.70 |
| Riverside, CACalifornia | $37.25 | $37.25 |
| Sacramento, CACalifornia | $37.85 | $37.85 |
| Salinas, CACalifornia | $37.69 | $37.69 |
| San Diego, CACalifornia | $38.06 | $38.06 |
| Marin County, CACalifornia | $41.70 | $41.70 |
| San Francisco, CACalifornia | $41.64 | $41.64 |
| San Benito County, CACalifornia | $42.52 | $42.52 |
| Santa Clara County, CACalifornia | $42.29 | $42.29 |
| San Luis Obispo, CACalifornia | $37.15 | $37.15 |
| Santa Cruz, CACalifornia | $38.03 | $38.03 |
| Santa Maria, CACalifornia | $37.69 | $37.69 |
| Santa Rosa, CACalifornia | $38.38 | $38.38 |
| Stockton, CACalifornia | $36.70 | $36.70 |
| Vallejo, CACalifornia | $39.98 | $39.98 |
| Visalia, CACalifornia | $36.70 | $36.70 |
| Yuba City, CACalifornia | $36.70 | $36.70 |
| ColoradoColorado | $36.66 | $36.66 |
| ConnecticutConnecticut | $37.70 | $37.70 |
| DelawareDelaware | $35.90 | $35.90 |
| Fort Lauderdale, FLFlorida | $37.56 | $37.56 |
| Rest of FloridaFlorida | $36.46 | $36.46 |
| Atlanta, GAGeorgia | $36.65 | $36.65 |
| Rest of GeorgiaGeorgia | $35.28 | $35.28 |
| Hawaii, Guam, HIHawaii | $36.79 | $36.79 |
| IowaIowa | $34.19 | $34.19 |
| IdahoIdaho | $34.36 | $34.36 |
| East St. Louis, ILIllinois | $36.94 | $36.94 |
| Rest of IllinoisIllinois | $36.11 | $36.11 |
| Suburban Chicago, ILIllinois | $37.81 | $37.81 |
| IndianaIndiana | $34.46 | $34.46 |
| KansasKansas | $34.25 | $34.25 |
| KentuckyKentucky | $34.78 | $34.78 |
| New Orleans, LALouisiana | $35.69 | $35.69 |
| Rest of LouisianaLouisiana | $34.81 | $34.81 |
| Metropolitan Boston, MAMassachusetts | $38.88 | $38.88 |
| Rest of MassachusettsMassachusetts | $36.67 | $36.67 |
| Baltimore area, MDMaryland | $37.61 | $37.61 |
| Rest of MarylandMaryland | $36.30 | $36.30 |
| Rest of MaineMaine | $34.61 | $34.61 |
| Southern Maine, MEMaine | $35.36 | $35.36 |
| MinnesotaMinnesota | $35.20 | $35.20 |
| Metropolitan Kansas City, MOMissouri | $35.40 | $35.40 |
| Metropolitan St. Louis, MOMissouri | $35.58 | $35.58 |
| Rest of MissouriMissouri | $34.60 | $34.60 |
| MississippiMississippi | $34.20 | $34.20 |
| MontanaMontana | $36.07 | $36.07 |
| North CarolinaNorth Carolina | $34.78 | $34.78 |
| North DakotaNorth Dakota | $35.08 | $35.08 |
| NebraskaNebraska | $34.24 | $34.24 |
| New HampshireNew Hampshire | $36.29 | $36.29 |
| Northern New JerseyNew Jersey | $39.36 | $39.36 |
| Rest of New JerseyNew Jersey | $38.15 | $38.15 |
| New MexicoNew Mexico | $35.55 | $35.55 |
| NevadaNevada | $35.80 | $35.80 |
| NYC suburbs and Long Island, NYNew York | $41.00 | $41.00 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $38.49 | $38.49 |
| Queens, NYNew York | $40.23 | $40.23 |
| Rest of New YorkNew York | $35.06 | $35.06 |
| OhioOhio | $35.19 | $35.19 |
| OklahomaOklahoma | $34.59 | $34.59 |
| Portland, OROregon | $37.18 | $37.18 |
| Rest of OregonOregon | $35.54 | $35.54 |
| Metropolitan Philadelphia, PAPennsylvania | $37.25 | $37.25 |
| Rest of PennsylvaniaPennsylvania | $35.13 | $35.13 |
| Puerto RicoPuerto Rico | $36.16 | $36.16 |
| Rhode IslandRhode Island | $36.69 | $36.69 |
| South CarolinaSouth Carolina | $35.04 | $35.04 |
| South DakotaSouth Dakota | $34.96 | $34.96 |
| TennesseeTennessee | $34.36 | $34.36 |
| Austin, TXTexas | $36.53 | $36.53 |
| Beaumont, TXTexas | $35.02 | $35.02 |
| Brazoria, TXTexas | $35.80 | $35.80 |
| Dallas, TXTexas | $36.01 | $36.01 |
| Fort Worth, TXTexas | $35.93 | $35.93 |
| Galveston, TXTexas | $35.91 | $35.91 |
| Houston, TXTexas | $36.82 | $36.82 |
| Rest of TexasTexas | $35.38 | $35.38 |
| UtahUtah | $35.28 | $35.28 |
| VirginiaVirginia | $35.41 | $35.41 |
| Virgin Islands, VIUnited States Virgin Islands | $36.16 | $36.16 |
| VermontVermont | $35.14 | $35.14 |
| Rest of WashingtonWashington | $36.54 | $36.54 |
| King County, WAWashington | $39.32 | $39.32 |
| WisconsinWisconsin | $34.48 | $34.48 |
| West VirginiaWest Virginia | $35.44 | $35.44 |
| WyomingWyoming | $35.64 | $35.64 |
93295 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$33.80
$48.02
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $48.02 | 1 |
| AL | $34.05 | 1 |
| AR | $33.80 | 1 |
| AZ | $35.51 | 1 |
| CA | $36.70–$42.52 | 29 |
| CO | $36.66 | 1 |
| CT | $37.70 | 1 |
| DC | $39.40 | 1 |
| DE | $35.90 | 1 |
| FL | $36.46–$39.05 | 3 |
| GA | $35.28–$36.65 | 2 |
| GU | $36.79 | 1 |
| HI | $36.79 | 1 |
| IA | $34.19 | 1 |
| ID | $34.36 | 1 |
| IL | $36.11–$38.46 | 4 |
| IN | $34.46 | 1 |
| KS | $34.25 | 1 |
| KY | $34.78 | 1 |
| LA | $34.81–$35.69 | 2 |
| MA | $36.67–$38.88 | 2 |
| MD | $36.30–$39.40 | 3 |
| ME | $34.61–$35.36 | 2 |
| MI | $35.39–$36.86 | 2 |
| MN | $35.20 | 1 |
| MO | $34.60–$35.58 | 3 |
| MS | $34.20 | 1 |
| MT | $36.07 | 1 |
| NC | $34.78 | 1 |
| ND | $35.08 | 1 |
| NE | $34.24 | 1 |
| NH | $36.29 | 1 |
| NJ | $38.15–$39.36 | 2 |
| NM | $35.55 | 1 |
| NV | $35.80 | 1 |
| NY | $35.06–$41.00 | 5 |
| OH | $35.19 | 1 |
| OK | $34.59 | 1 |
| OR | $35.54–$37.18 | 2 |
| PA | $35.13–$37.25 | 2 |
| PR | $36.16 | 1 |
| RI | $36.69 | 1 |
| SC | $35.04 | 1 |
| SD | $34.96 | 1 |
| TN | $34.36 | 1 |
| TX | $35.02–$36.82 | 8 |
| UT | $35.28 | 1 |
| VA | $35.41–$39.40 | 2 |
| VI | $36.16 | 1 |
| VT | $35.14 | 1 |
| WA | $36.54–$39.32 | 2 |
| WI | $34.48 | 1 |
| WV | $35.44 | 1 |
| WY | $35.64 | 1 |
How the 93295 rate is calculated
Each of 93295’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 93295
RVUs × geographic indexes × conversion factor
Work0.72
0.72 RVUs× 1.000 GPCI
Practice expense0.31
0.31 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
1.0800
Conversion factor
$33.4009
Medicare rate
$36.07
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Detroit, MI inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,032
- Code
- 93295
- Physician work
- 0.72
- Practice expense
- 0.31
- Malpractice
- 0.05
GPCI2026.csv
64
- Locality
- Detroit, MI
- Physician work
- 1.000
- Practice expense
- 0.965
- Malpractice
- 1.686
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.72 | × 1.000 | 0.7200 |
| Practice expense | 0.31 | × 0.965 | 0.2991 |
| Malpractice | 0.05 | × 1.686 | 0.0843 |
| Total RVUs | 1.1035 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Detroit, MI$36.86
Office: (0.72 × 1 + 0.31 × 0.965 + 0.05 × 1.686) × $33.4009 = $36.86
Facility: (0.72 × 1 + 0.31 × 0.965 + 0.05 × 1.686) × $33.4009 = $36.86
Payment rules and modifiers for 93295
The CMS indicators that decide how 93295 is paid alongside other services.
CMS payment indicators · 93295
Remote ICD check, defibrillator, professional review, up to 90 days
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 2 | Professional component only. |
How 93295 has changed in Detroit, MI
93295 · Office / nonfacility
$36.86
Effective 2026-10-01
The base rate is $1.38 higher than on 2025-10-01, moving from $35.48 to $36.86 (3.9%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$35.48changed to$36.86
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.74 changed to 0.72
- Practice expense RVU 0.29 changed to 0.31
- Malpractice RVU 0.04 changed to 0.05
- Work GPCI 1.003 changed to 1.000
- Practice expense GPCI 0.986 changed to 0.965
- Malpractice GPCI 1.718 changed to 1.686
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$37.08changed to$35.48
- Conversion factor 33.2875 changed to 32.3465
- Malpractice RVU 0.05 changed to 0.04
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$36.48changed to$37.08
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$37.43changed to$36.48
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.30 changed to 0.29
- Malpractice RVU 0.04 changed to 0.05
- Work GPCI 1.000 changed to 1.003
- Practice expense GPCI 0.992 changed to 0.986
- Malpractice GPCI 1.670 changed to 1.718
January 1, 2023
RVU23A
$38.77changed to$37.43
- Conversion factor 34.6062 changed to 33.8872
- Malpractice RVU 0.05 changed to 0.04
- Practice expense GPCI 0.997 changed to 0.992
- Malpractice GPCI 1.622 changed to 1.670
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$39.09changed to$38.77
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$40.45changed to$39.09
- Conversion factor 36.0896 changed to 34.8931
- Practice expense GPCI 0.993 changed to 0.997
- Malpractice GPCI 1.657 changed to 1.622
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$46.47changed to$40.45
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 0.47 changed to 0.30
- Practice expense GPCI 0.989 changed to 0.993
- Malpractice GPCI 1.691 changed to 1.657
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$57.10changed to$46.47
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 0.77 changed to 0.47
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$70.40changed to$57.10
- Conversion factor 35.8887 changed to 35.9996
- Work RVU 1.29 changed to 0.74
- Practice expense RVU 0.54 changed to 0.77
- Malpractice RVU 0.09 changed to 0.05
- Practice expense GPCI 0.992 changed to 0.989
- Malpractice GPCI 1.510 changed to 1.691
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$69.33changed to$70.40
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 0.53 changed to 0.54
- Practice expense GPCI 0.994 changed to 0.992
- Malpractice GPCI 1.328 changed to 1.510
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$69.58changed to$69.33
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$69.23changed to$69.58
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$69.97changed to$69.23
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 0.52 changed to 0.53
- Malpractice RVU 0.08 changed to 0.09
- Work GPCI 1.010 changed to 1.000
- Practice expense GPCI 1.009 changed to 0.994
- Malpractice GPCI 1.571 changed to 1.328
Held through RVU15B.
January 1, 2014
RVU14A
$67.89changed to$69.97
- Conversion factor 34.0230 changed to 35.8228
- Work GPCI 1.022 changed to 1.010
- Practice expense GPCI 1.023 changed to 1.009
- Malpractice GPCI 1.814 changed to 1.571
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $67.89
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $36.86 | $36.86 | RVU26D |
| 2026-07-01 | $36.86 | $36.86 | RVU26C |
| 2026-04-01 | $36.86 | $36.86 | RVU26B |
| 2026-01-01 | $36.86 | $36.86 | RVU26A |
| 2025-10-01 | $35.48 | $35.48 | RVU25D |
| 2025-07-01 | $35.48 | $35.48 | RVU25C |
| 2025-04-01 | $35.48 | $35.48 | RVU25B |
| 2025-01-01 | $35.48 | $35.48 | RVU25A |
| 2024-10-01 | $37.08 | $37.08 | RVU24D |
| 2024-07-01 | $37.08 | $37.08 | RVU24C |
| 2024-04-01 | $37.08 | $37.08 | RVU24B |
| 2024-03-09 | $37.08 | $37.08 | RVU24AR |
| 2024-01-01 | $36.48 | $36.48 | RVU24A |
| 2023-10-01 | $37.43 | $37.43 | RVU23D |
| 2023-07-01 | $37.43 | $37.43 | RVU23C |
| 2023-04-01 | $37.43 | $37.43 | RVU23B |
| 2023-01-01 | $37.43 | $37.43 | RVU23A |
| 2022-10-01 | $38.77 | $38.77 | RVU22D |
| 2022-07-01 | $38.77 | $38.77 | RVU22C |
| 2022-04-01 | $38.77 | $38.77 | RVU22B |
| 2022-01-01 | $38.77 | $38.77 | RVU22A |
| 2021-10-01 | $39.09 | $39.09 | RVU21D |
| 2021-07-01 | $39.09 | $39.09 | RVU21C |
| 2021-04-01 | $39.09 | $39.09 | RVU21B |
| 2021-01-01 | $39.09 | $39.09 | RVU21A |
| 2020-10-01 | $40.45 | $40.45 | RVU20D |
| 2020-07-01 | $40.45 | $40.45 | RVU20C |
| 2020-04-01 | $40.45 | $40.45 | RVU20B |
| 2020-01-01 | $40.45 | $40.45 | RVU20A |
| 2019-10-01 | $46.47 | $46.47 | RVU19D |
| 2019-07-01 | $46.47 | $46.47 | RVU19C |
| 2019-04-01 | $46.47 | $46.47 | RVU19B |
| 2019-01-01 | $46.47 | $46.47 | RVU19A |
| 2018-10-01 | $57.10 | $57.10 | RVU18D |
| 2018-07-01 | $57.10 | $57.10 | RVU18C |
| 2018-04-01 | $57.10 | $57.10 | RVU18B |
| 2018-01-01 | $57.10 | $57.10 | RVU18AR1 |
| 2017-10-01 | $70.40 | $70.40 | RVU17D |
| 2017-07-01 | $70.40 | $70.40 | RVU17C |
| 2017-04-01 | $70.40 | $70.40 | RVU17B |
| 2017-01-01 | $70.40 | $70.40 | RVU17A |
| 2016-10-01 | $69.33 | $69.33 | RVU16D |
| 2016-07-01 | $69.33 | $69.33 | RVU16C |
| 2016-04-01 | $69.33 | $69.33 | RVU16B |
| 2016-01-01 | $69.33 | $69.33 | RVU16A |
| 2015-10-01 | $69.58 | $69.58 | RVU15D |
| 2015-07-01 | $69.58 | $69.58 | RVU15C |
| 2015-04-01 | $69.23 | $69.23 | RVU15B |
| 2015-01-01 | $69.23 | $69.23 | RVU15A |
| 2014-10-01 | $69.97 | $69.97 | RVU14D |
| 2014-07-01 | $69.97 | $69.97 | RVU14C |
| 2014-04-01 | $69.97 | $69.97 | RVU14B |
| 2014-01-01 | $69.97 | $69.97 | RVU14A |
| 2013-10-01 | $67.89 | $67.89 | RVU13D |
| 2013-07-01 | $67.89 | $67.89 | RVU13C |
| 2013-04-01 | $67.89 | $67.89 | RVU13B |
| 2013-01-01 | $67.89 | $67.89 | RVU13AR |
Where the Detroit, MI rate applies
Detroit, MI is a Medicare payment area, not a city. Our Census mapping connects it to 98 cities and communities in Michigan. Some span more than one payment area; confirm with the service ZIP.
- Detroit
- Allen Park
- Ann Arbor
- Armada
- Auburn Hills
- Barton Hills
- Belleville
- Berkley
93295 billing questions
How often can this code be reported?
Report it once for a remote interrogation period of up to 90 days, not for each transmission or interim report. Document the clinician's review and report for the period billed.
Does this code include the technical service?
No. Code 93295 covers the clinician's analysis and report; 93296 separately covers remote data acquisition and related technical work.
Should 93294 or 93295 be used for a patient with a CRT device?
Code by device type. A cardiac resynchronization defibrillator (CRT-D) uses 93295, while a cardiac resynchronization pacemaker without defibrillation capability (CRT-P) uses 93294.
Is modifier 26 needed?
No. Code 93295 already represents only the professional interpretation and report, so do not append modifier 26.
Do single-, dual-, and multiple-lead ICDs use different remote professional codes?
No. Code 93295 covers remote professional review for all three lead configurations; in-person programming evaluations are distinguished by lead configuration.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 93295 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist