CMS To Delete 90-Day Remote Monitoring Pacemaker and ICD Edits Retroactive To January 1, 2009

On April 1, 2009, the Centers for Medicare and Medicaid Services (CMS) will retroactively reverse a National Correct Coding Initiative (NCCI) edit implemented on January 1, 2009 (Version 15.0) that prohibited billing CPT® code 93294 with 93296 and 93295 with 93296.

CPT codes 93294 and 93295, used to report the professional component of a 90-day remote monitoring period for a pacemaker or implantable cardioverter defibrillator service, could not be reported with 93296, the technical component of the service.

While in some cases the technical component may be billed by a separate independent diagnostic testing facility (IDTF), it may also be billed by the physician practice if they have the technical capability to do so. With these edits in place, there was no way to bill for global services prior to April 1.

The Society identified this major error when Version 15.0 edits were finalized. CMS was urged at that time to rescind the edits before January 1 to avoid confusion with the new device monitoring codes that went into effect the beginning of this year. CMS has confirmed that the deletion will be retroactive to the implementation date of the edits. Providers that received claim denials based on the edits prior to April 1, 2009 may resubmit or appeal their claims.

To learn more about NCCI edits, visit CMS’ website

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