External patient-activated loop recorder, 30-day monitoring; includes monitor, hook-up, recording, and download

CPT 93268 is the billing code for "External patient-activated loop recorder, 30-day monitoring; includes monitor, hook-up, recording, and download". For external patient-activated loop recorder for 30-day monitoring

Medicare pays approximately $163.35 for CPT 93268 (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 93268 has a total RVU of 6.18, broken down as: Work RVU 1.80, Practice Expense RVU 4.20, and Malpractice RVU 0.18. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 93268 include: Indication for loop recorder; Duration of monitoring; Patient activation events; Analysis findings and report. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 93268: Includes 30-day monitoring. Includes monitor, hook-up, recording, and download Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 93268 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 93268 is 30 days monitoring period. Time-based codes require documentation of the actual time spent providing the service.