Billing code 93642: ICD evaluationMedicare rate & RVUs in Florida
Reports electrophysiologic assessment of a transvenous implantable cardioverter-defibrillator, including evaluation of its sensing and arrhythmia-termination functions.
Medicare pays $339.28–$384.07 for 93642 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
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 9 sections
What 93642 covers
93642 is for an electrophysiologic assessment of a transvenous implantable cardioverter-defibrillator (ICD). The electrophysiologist evaluates how the device senses cardiac signals and delivers pacing or therapy to terminate an arrhythmia, and may program or reprogram the device as part of that assessment. This work is distinct from a routine device check. It is typically performed by a cardiologist or electrophysiologist in a hospital or electrophysiology laboratory when testing of the ICD’s response is clinically needed.
Report the service for the transvenous ICD evaluation, not for a routine interrogation alone or an evaluation performed as part of implantation or replacement. Documentation should identify the device and record the testing performed, findings, and any programming changes. This diagnostic service may be billed globally or as the professional interpretation with modifier 26 or the technical service with modifier TC. Same-day preoperative and postoperative care is included in its 0-day global period. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate; an assistant is paid only when medical necessity is documented, and co-surgeon and team-surgery billing are not permitted.
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.
Where 93642 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$339.28 to $384.07
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $357.29 | Unavailable |
| Miami | $384.07 | Unavailable |
| Rest Of Florida | $339.28 | Unavailable |
How the 93642 rate is calculated
Each of 93642’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 · 93642
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.51Practice expense 4.43Malpractice 0.94
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 93642
The CMS indicators that decide how 93642 is paid alongside other services.
CMS payment indicators · 93642
ICD evaluation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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 | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
93642 without 26 · national office
$330.00
ICD evaluation
93642-26 · Professional component
$246.50
Pays only the interpretation and report.
93642 compared with similar codes
Compare codes
93642 vs 93641 vs 93644 vs 93283: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 93641Ep evl 1/2chmb pac cvdfb tst
- 93641 is for electrophysiologic evaluation at ICD implantation or replacement. 93642 describes evaluation of a transvenous ICD outside that implant-or-replacement circumstance.
- 93644Defibrillator evaluation
- 93644 is specific to evaluation of a subcutaneous implantable defibrillator system. 93642 is for a transvenous ICD.
- 93283ICD evaluation
- 93283 is a device evaluation and programming service for a dual-lead ICD. 93642 represents electrophysiologic assessment of the transvenous ICD’s sensing and arrhythmia-termination functions.
93642 billing questions
How is 93642 different from a routine ICD check?
93642 describes electrophysiologic assessment of a transvenous ICD’s sensing and arrhythmia-termination functions. A routine device evaluation or programming service does not, by itself, support this code.
Can device programming be reported separately?
Programming or reprogramming performed as part of the electrophysiologic evaluation is included in 93642. Do not separately report that work as a routine device programming service for the same work.
When should 93641 be considered instead?
93641 applies to an electrophysiologic evaluation performed at the time of ICD implantation or replacement. Use 93642 for the transvenous ICD evaluation when the service is not that implant-or-replacement evaluation.
Can the professional and technical portions be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service; billing without either modifier represents the global service.
Can modifier 50 or an assistant modifier be used?
Modifier 50 is inappropriate for this code. Assistant-at-surgery payment is available only when medical necessity is documented.
What should the record include?
Document the transvenous ICD, the electrophysiologic testing and evaluation performed, the findings, and any programming changes. The record should distinguish this assessment from routine device follow-up.
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
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