External electrocardiographic recording >48 hours up to 21 days by continuous rhythm recording and storage; includes recording, scanning analysis with report
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Extended ECG monitoring >21 days not justified - implantable recorder indicated
Occasional93226 (external ECG >21 days up to 30 days) rarely necessary - symptoms this infrequent usually require implantable loop recorder for longer monitoring (up to 3 years). Denied when symptoms less than weekly (implantable device indicated), when shorter monitoring adequate, or when diagnosis already established.
Common Causes
- • Symptoms monthly or less - external monitor unlikely to capture, need implantable loop recorder
- • Extended monitoring for medication efficacy - not typically covered
- • Billing 30-day monitor when symptoms more frequent - shorter duration would suffice
Resolution Strategy
Document symptoms weekly justifying extended external monitoring: 'Patient with unexplained syncope, approximately once weekly. Prior 14-day monitor non-diagnostic, no symptoms during monitoring. Extended 30-day external monitoring prescribed to maximize capture before considering implantable loop recorder. Patient declined implantable device, prefers external option first. Day 23: Syncope episode captured, correlating with 8-second sinus pause diagnostic of sinus node dysfunction.' Alternative: 'Patient with weekly palpitations, 21-day monitor ordered. Implantable loop recorder not covered by insurance, external extended monitor only option.' Must document: weekly symptoms, prior shorter monitoring non-diagnostic, reason for external vs implantable (patient preference, insurance coverage). If symptoms monthly, must justify why implantable not used.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For extended ECG monitoring >48 hours up to 21 days with analysis and report only
Common Scenarios
Documentation Requirements
- Indication for extended monitoring
- Duration of monitoring
- Analysis findings
- Report documentation
- No physician interpretation
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes >48 hours up to 21 days monitoring
- Includes analysis and report
- Interpretation coded separately
- Shorter monitoring requires separate code
- ECG coded separately
Exclusions
- 93224 (external ECG recording up to 48 hours)
- 93225 (external ECG recording >48 hours with interpretation)
- 93227 (external ECG recording >48 hours, review and interpretation only)
- 93268 (external patient-activated loop recorder)
Coding Notes
Clinical scenarios
- Indication for extended monitoring
- Duration of monitoring
- Analysis findings
- Indication for extended monitoring
- Duration of monitoring
- Analysis findings
- Indication for extended monitoring
- Duration of monitoring
- Analysis findings
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 93226 is the billing code for "External electrocardiographic recording >48 hours up to 21 days by continuous rhythm recording and storage; includes recording, scanning analysis with report". For extended ECG monitoring >48 hours up to 21 days with analysis and report only
Medicare pays approximately $33.32 for CPT 93226 (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 93226 has a total RVU of 4.52, broken down as: Work RVU 1.20, Practice Expense RVU 3.20, and Malpractice RVU 0.12. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 93226 is "Extended ECG monitoring >21 days not justified - implantable recorder indicated". 93226 (external ECG >21 days up to 30 days) rarely necessary - symptoms this infrequent usually require implantable loop recorder for longer monitoring (up to 3 years). Denied when symptoms less than weekly (implantable device indicated), when shorter monitoring adequate, or when diagnosis already established. Common causes include: Symptoms monthly or less - external monitor unlikely to capture, need implantable loop recorder; Extended monitoring for medication efficacy - not typically covered. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 93226 include: Indication for extended monitoring; Duration of monitoring; Analysis findings; Report documentation. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 93226: Includes >48 hours up to 21 days monitoring. Includes analysis and report Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 93226 include: TC (Technical 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 93226 is >48 hours up to 21 days monitoring period. Time-based codes require documentation of the actual time spent providing the service.