Summary & Overview
CPT 0826T: Leadless Single-Chamber Pacemaker Programming and Evaluation
CPT code 0826T covers in-person evaluation and iterative testing with adjustment of programmed settings for an implanted single-chamber leadless pacemaker, including analysis and a report. This code captures a specialized device-management service that supports safe and effective therapy for patients with leadless cardiac pacing systems. Nationally, the code is relevant as use of leadless pacemakers grows and as payers clarify coverage and payment policies for advanced device programming and interrogation.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coverage and coding considerations across major commercial payers and the Medicare program, noting common modifier usage and billing contexts where available.
Readers will learn the clinical and billing scope of the service, typical sites of care where the procedure is performed, and practical considerations for documentation and reporting. The report summarizes benchmarks where available, recent policy updates that affect device-management services, and the clinical context for leadless single-chamber pacemaker programming. Data not available in the input is identified explicitly in specific sections.
Billing Code Overview
CPT code 0826T describes an in-person evaluation and repeated testing and adjustment of the programmed settings of an implanted single-chamber leadless pacemaker system. The service includes analysis, review of device interrogation results, and a written report.
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Service type: Device programming, interrogation, and management for an implanted leadless single-chamber pacemaker
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Typical site of service: Hospital outpatient department or ambulatory clinic where device interrogation and programming are performed
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with symptomatic bradycardia and a previously implanted single-chamber leadless pacemaker presents for programmed-device interrogation and in‑person reprogramming. The device has been implanted for several months and the patient reports intermittent dizziness and near-syncope. The clinic visit includes a focused history and physical, interrogation of the leadless pacemaker using the manufacturer programmer, repeated testing of sensing and capture thresholds, adjustment of pacing output and mode parameters, evaluation of device telemetry and battery status, and documentation of changes in the medical record with an interpretive report. The workflow typically involves a cardiac electrophysiologist or device clinic nurse/technologist performing the device interrogation and adjustments in an outpatient electrophysiology clinic or ambulatory surgical center; complex adjustments or troubleshooting are performed by the attending electrophysiologist during the same encounter. The service includes real-time testing, multiple programming iterations to achieve appropriate sensing and capture, review of stored diagnostics, and a written report of findings and device settings for inclusion in the patient record and communication to the referring cardiologist and primary care provider.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural service | Use when the work required to evaluate and reprogram the device is substantially greater than typical due to complexity or complications. |