93642 ICD evaluation Medicare reimbursement rates in Utah

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.