Summary & Overview
CPT 0575T: ICD Programming Evaluation and Device Reprogramming
CPT code 0575T represents an in-person evaluation and iterative reprogramming of an already implanted cardioverter–defibrillator (ICD) system performed by an OQHCP or physician. The code encompasses the hands-on assessment, repeated adjustments of device components, and the clinician's analysis and report of the selected permanent programmed values. This service supports optimization of ICD function and patient safety by tailoring device parameters to individual clinical needs.
Key national payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise account of how CPT code 0575T is defined clinically and operationally, plus what to expect in typical sites of service such as hospital-based device clinics and outpatient cardiology settings. The publication presents benchmarks and policy-relevant context for coverage and billing practices, outlines common billing considerations, and summarizes clinical context that drives utilization of device programming services. Specific payer policy details, coding variants, and related claims-handling practices are included where available.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
CPT code 0575T describes an in-person clinical service in which an OQHCP or physician evaluates an already implanted cardioverter–defibrillator (ICD) system and repeatedly adjusts the device's programmed settings to determine and select the optimal permanent programmed values. The service includes the clinician's analysis, review, and a report of findings and the final programmed settings.
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Service type: Device programming and reprogramming evaluation with iterative adjustments
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Typical site of service: Hospital inpatient or outpatient cardiology clinic, device clinic, or other facility where implanted cardiac devices are managed
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with ischemic cardiomyopathy and a previously implanted transvenous implantable cardioverter–defibrillator (ICD) presents for an in-person device evaluation. The patient reports occasional palpitations and one suspected shock event. The device clinic visit is scheduled as a focused programming session to interrogate the ICD, review arrhythmia logs, assess lead integrity and sensing thresholds, and repeatedly adjust therapy and detection parameters to determine optimal permanent programmed values. The office or outpatient clinic workflow includes device interrogation using the manufacturer programmer, analysis of stored electrograms, reprogramming of tachycardia detection zones, adjusting pacing and shock energies, documention of changes and rationale, and communication of findings in a written report placed in the medical record. If intra-procedural issues arise (for example, lead malfunction, recurrent inappropriate therapies, or symptoms during reprogramming), additional interventions or inpatient monitoring may follow per clinical decision-making.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician's professional service separate from a facility or technical component. |
52 | Reduced services | Use when the programming session is abbreviated and less than typically required. |
53 | Discontinued procedure | Use when the reprogramming attempt is started but stopped due to patient instability or equipment failure. |
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period | Use if the patient requires an immediate repeat reprogramming procedure in the same global period. |
80 | Assistant surgeon | Use when a surgical assistant is documented and meets payer requirements for an assistant at programming-related operative procedures. |
62 | Two surgeons | Use when dual surgeons are documented as necessary for a related operative procedure during the same encounter. |
22 | Increased procedural services | Use when the programming required substantially greater work than typical and documentation supports the increased complexity. |
51 | Multiple procedures | Use when this programming service is reported on the same day with other distinct procedures and payer rules require modifier 51. |
26 | Technical note: already listed above | Duplicate 26 omitted in practice; only include once in submission. |
23 | Unusual anesthesia | Use when general anesthesia or MAC is medically necessary for the programming procedure and anesthesia is unusual for this service. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Cardiology | Electrophysiologists and cardiologists frequently perform device evaluations and programming. |
| 207RH00000X | Cardiac Electrophysiology | Subspecialty focused on device management, ICD programming, and arrhythmia therapy. |
| 208D00000X | Internal Medicine | Hospitalists or internists may be involved in inpatient device adjustments or evaluations. |
| 367500000X | Physician Assistant (Cardiology) | PAs commonly perform device clinic evaluations under physician oversight. |
| 363A00000X | Registered Nurse Practitioner (Cardiology) | NPs frequently perform in-person device interrogations and programming in clinic settings. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris | Underlying ischemic cardiomyopathy can lead to reduced ejection fraction and ICD implantation for sudden cardiac death prevention. |
I50.22 | Chronic systolic (congestive) heart failure | Reduced left ventricular function is a common indication for ICD implantation and for subsequent device programming adjustments. |
I46.9 | Cardiac arrest, cause unspecified | Patients with prior cardiac arrest may have ICDs; programming is tailored to prevent recurrent ventricular arrhythmias. |
I49.01 | Ventricular fibrillation | Primary arrhythmic substrate requiring ICD detection and therapy zone programming. |
I49.02 | Ventricular tachycardia | ICD detection and therapy parameters are adjusted to treat VT appropriately while minimizing inappropriate shocks. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
93288 | Programming device evaluation (in-person) of pacemaker and/or implantable defibrillator system; analysis, review and report by a physician or qualified healthcare professional | Often used for initial or routine device reprogramming and formal programming evaluation; overlaps with 0575T when reporting standard programming services. |
93290 | Programming device evaluation (remote) of pacemaker and/or implantable defibrillator system; analysis, review and report by a physician or qualified healthcare professional | Used for remote monitoring and programming-related evaluation separate from in-person 0575T visits. |
33249 | Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s) | Performed when device revision or lead replacement is required after evaluation reveals hardware failure during programming. |
93294 | Interrogation device evaluation (in-person or remote) of implanted pacemaker or defibrillator with programming, includes analysis and report | Used for comprehensive interrogation and programming sessions; may be reported for more extensive programming services depending on payer rules. |
99457 | Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time | Supports ongoing remote device data management that complements in-person programming and follow-up. |