$46.15
Both concern an implantable cardiovascular event recorder and are performed in person. Choose 93285 when the service includes iterative programming adjustments and testing; 93291 is for interrogation and evaluation.
On this page
CMS RVU26D · Effective 2026-10-01
93285 Device programming Medicare reimbursement rates in Wisconsin
An in-person evaluation adjusts and tests selected settings on an implantable loop recorder, with review and interpretation by a physician or qualified professional. Compare 93285 office and facility rates across CMS payment localities in Wisconsin.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 93285 in Wisconsin?
Wisconsin has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$57.02
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Cardiac device services
About 93285: Implantable loop recorder programming evaluation
An in-person evaluation adjusts and tests selected settings on an implantable loop recorder, with review and interpretation by a physician or qualified professional.
This service is for an in-person programming evaluation of an implantable cardiovascular event recorder, commonly called an implantable loop recorder. A cardiologist, electrophysiologist, or other qualified health care professional assesses selected device functions and iteratively adjusts settings to test them. These recorders may be used to monitor patients with unexplained syncope, suspected intermittent arrhythmias, or other indications for long-term rhythm monitoring. The service may occur in a cardiology office or hospital setting.
Report the code when the encounter includes the programming evaluation and interpretation, rather than only review of stored device data. Documentation should identify the device, the functions and settings evaluated, any adjustments and testing performed, and the clinician’s interpretation. CMS recognizes professional and technical components: modifier 26 identifies the interpretation, modifier TC identifies equipment and staff, and an unmodified claim represents the global service. The cardiovascular diagnostic multiple procedure reduction applies to the technical component.
CMS billing rules for 93285
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
- Multiple procedures
- Cardiovascular diagnostic multiple procedure reduction applies to the technical component.
Where the value comes from
- Work RVU0.51 · 29%
- Practice expense (office) RVU1.24 · 70%
- Malpractice RVU0.03 · 2%
42.6K
Medicare services in 2024 · #842 by national volume
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.
93285 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$98.72
93298 is for remote interrogation and evaluation of an implantable event recorder. This code describes an in-person programming evaluation.
$64.23
93279 concerns programming evaluation of a pacemaker. This code applies to programming evaluation of an implantable cardiovascular event recorder.
Compare 93285 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Wisconsin →
Office / nonfacility
$57.02
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 93285 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
12,004
- Code
- 93285
- Physician work
- 0.51
- Practice expense
- 1.24
- Malpractice
- 0.03
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.51 | × 1.000 | 0.5100 |
| Practice expense | 1.24 | × 0.958 | 1.1879 |
| Malpractice | 0.03 | × 0.308 | 0.0092 |
| Total RVUs | 1.7072 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$57.02
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.51 | 1 |
| Practice expense | 1.24 | 0.958 |
| Malpractice | 0.03 | 0.308 |
(0.51 × 1 + 1.24 × 0.958 + 0.03 × 0.308) × $33.4009 = $57.02
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
93285 billing questions
When should this code be chosen instead of 93291?
Use this code for an in-person programming evaluation that includes iterative adjustment and testing of selected settings. Code 93291 describes in-person interrogation and evaluation of the recorder without that programming service.
Can the professional and technical components be billed separately?
Yes. Modifier 26 identifies the professional interpretation, and modifier TC identifies the technical service involving equipment and staff. Reporting the code without either modifier represents the global service.
How does the multiple procedure reduction affect this service?
The cardiovascular diagnostic multiple procedure reduction applies to the technical component. It does not apply to the professional component under the CMS facts for this code.
Is this code appropriate for a remote recorder review?
No. This code describes an in-person programming evaluation; remote interrogation of an implantable event recorder is represented by 93298.
What documentation supports reporting the programming evaluation?
Document the recorder evaluated, the selected functions or settings tested, any iterative adjustments, and the interpreting clinician’s findings.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,00193284,,Prgrmg eval implantable dfb,A,,1.22,1.85,,1.85,NA,0.05,3.12,3.12,1,XXX,0.00,0.00,0.00,6,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,00293284,26,Prgrmg eval implantable dfb,A,,1.22,0.51,,0.51,,0.04,1.77,1.77,1,XXX,0.00,0.00,0.00,6,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,00393284,TC,Prgrmg eval implantable dfb,A,,0.00,1.34,,1.34,NA,0.01,1.35,1.35,1,XXX,0.00,0.00,0.00,6,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
12,00493285,,Prgrmg dev eval scrms ip,A,,0.51,1.24,,1.24,NA,0.03,1.78,1.78,1,XXX,0.00,0.00,0.00,6,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,00593285,26,Prgrmg dev eval scrms ip,A,,0.51,0.22,,0.22,,0.02,0.75,0.75,1,XXX,0.00,0.00,0.00,6,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,00693285,TC,Prgrmg dev eval scrms ip,A,,0.00,1.02,,1.02,NA,0.01,1.03,1.03,1,XXX,0.00,0.00,0.00,6,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
12,00793286,,Peri-px eval pm/ldls pm ip,A,,0.29,1.02,,1.02,NA,0.02,1.33,1.33,1,XXX,0.00,0.00,0.00,6,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,