Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Bundled with office visit - no separate medical necessity
Common93000 (EKG complete) billed on same day as E/M may be denied as bundled unless there's clear, separate medical necessity for the EKG.
Common Causes
- • Routine EKG performed during preventive visit
- • EKG for same indication as E/M visit
- • No documentation of why EKG was separately necessary
Resolution Strategy
Document clear medical necessity for EKG separate from E/M visit (e.g., chest pain evaluation, new palpitations, medication monitoring). May require Modifier 59.
💬 Plain Language Explanation
What this means
This is an electrocardiogram (EKG or ECG) - a test that measures your heart's electrical activity. Electrodes were placed on your chest to record your heart rhythm.
Why you might see this
You'll see this code when your doctor orders an EKG to check your heart rhythm, screen for heart problems, or monitor a heart condition. This is a common test, especially for patients with heart concerns or during routine check-ups for certain age groups.
Common context
Common heart screening test, often used for patients with heart symptoms or as part of routine screening.
What to ask your provider
"'Why was this EKG ordered? Were the results normal? Was this part of a routine screening or for a specific concern?'"
Relative Value Units (RVUs)
Calculator →
Clinical Information
When to Use
For routine 12-lead ECG with interpretation and report
Common Scenarios
Documentation Requirements
- Indication for ECG
- 12-lead ECG tracing
- Heart rate and rhythm
- Interpretation and report
- Any abnormalities noted
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes 12-lead ECG
- Includes interpretation and report
- Tracing only coded separately
- Interpretation only coded separately
- Stress test ECG coded separately
Exclusions
- 93005 (ECG, tracing only)
- 93010 (ECG, interpretation and report only)
- 93040 (rhythm ECG, 1-3 leads)
- 93015 (cardiovascular stress test)
Coding Notes
Medical Necessity: ICD-10
Clinical scenarios
- Indication for ECG
- 12-lead ECG tracing
- Heart rate and rhythm
- Indication for ECG
- 12-lead ECG tracing
- Heart rate and rhythm
- Indication for ECG
- 12-lead ECG tracing
- Heart rate and rhythm
Who are you?
Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
Automate Coding
Let OrbDoc AI automatically suggest codes from your clinical notes.
Patient? Check your bill.
Use our free analyzer to understand charges and spot errors.
Analyze My BillAsk OrbDoc AI
Get instant answers about 93000 - pricing, bundling rules, or billing questions.
Ask a QuestionFrequently Asked Questions
CPT 93000 is the billing code for "Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report". For routine 12-lead ECG with interpretation and report
Medicare pays approximately $13.91 for CPT 93000 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 93000 has a total RVU of 1.75, broken down as: Work RVU 0.50, Practice Expense RVU 1.20, and Malpractice RVU 0.05. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 93000 is "Bundled with office visit - no separate medical necessity". 93000 (EKG complete) billed on same day as E/M may be denied as bundled unless there's clear, separate medical necessity for the EKG. Common causes include: Routine EKG performed during preventive visit; EKG for same indication as E/M visit. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 93000 include: Indication for ECG; 12-lead ECG tracing; Heart rate and rhythm; Interpretation and report. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 93000: Includes 12-lead ECG. Includes interpretation and report Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 93000 include: 26 (Professional component only (interpretation)), TC (Technical component only (equipment/staff)), 59 (Distinct procedural service if performed separately). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 93000 is 5-10 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.