Rhythm ECG, 1-3 leads; interpretation and report only

CPT 93042 is the billing code for "Rhythm ECG, 1-3 leads; interpretation and report only". For interpretation and report of previously obtained rhythm ECG

Medicare pays approximately $6.47 for CPT 93042 (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 93042 has a total RVU of 0.52, broken down as: Work RVU 0.20, Practice Expense RVU 0.30, and Malpractice RVU 0.02. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 93042 include: Indication for rhythm ECG interpretation; Rhythm interpretation findings; Heart rate and rhythm; Findings and conclusions. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 93042: Includes interpretation and report only. Tracing coded separately Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 93042 include: 26 (Professional component only), 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 93042 is 2-3 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.