Summary & Overview
CPT 0804T: In-Person Programming and Evaluation of Dual-Chamber Leadless Pacemaker System
CPT code 0804T captures an in-person clinical service for comprehensive device management of an implanted dual-chamber leadless pacemaker system, including repeated testing, adjustment of programmed settings, analysis of results, and a written report. This code matters nationally as use of leadless cardiac pacing technology grows and payers and providers seek standardized pathways to document and reimburse device programming and follow-up care. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what CPT code 0804T represents clinically and operationally, the typical sites where the service is delivered, and which major national payers are relevant to coverage and payment considerations. The publication outlines benchmarks and policy context related to device management codes, highlights the clinical workflow for in-person device interrogation and reprogramming, and summarizes reporting expectations tied to the code. Data not available in the input is identified where applicable. This summary supports clinical, coding, and administrative audiences seeking a concise national overview of billing for advanced leadless pacemaker programming and evaluation services.
Billing Code Overview
CPT code 0804T describes an in-person evaluation with repeated testing and adjustment of programmed settings for an implanted dual-chamber leadless pacemaker system. The service includes analysis, review of device test results, adjustment of pacing parameters, and a written report documenting findings and actions.
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Service Type: Device interrogation, programming, and management of an implanted cardiac leadless pacemaker system
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Typical Site of Service: In-person outpatient clinic or hospital outpatient setting where device programming and direct patient evaluation can be performed
Clinical & Coding Specifications
Clinical Context
A 76-year-old patient with symptomatic bradycardia and intermittent syncope presents for in-person evaluation and device reprogramming after implantation of a dual-chamber leadless pacemaker system. The patient arrives to an outpatient cardiology electrophysiology clinic or a hospital-based device clinic for a scheduled follow-up visit. The clinical workflow includes: review of the implant procedure and recent device data, a focused history and targeted cardiac exam, interrogation of the implanted device using the manufacturer programmer, repeated in-clinic testing of sensing and pacing thresholds in both channels, stepwise adjustment of programmed parameters (including output voltages, pulse widths, sensing polarity, AV timing, and rate response settings), verification of capture and sensing after each adjustment, analysis and interpretation of device logs and telemetry, and preparation of a written report documenting findings and final programmed settings. Typical sites of service include an outpatient electrophysiology clinic, hospital-based device clinic, or same-day observation unit. The visit addresses symptom correlation with device function and ensures appropriate device performance for chronic therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician’s professional work separate from technical services provided by the facility or device vendor during device interrogation and programming |