Summary & Overview
CPT 0926T: Implantable Cardiac Contractility Modulation–Defibrillation Device Programming
CPT code 0926T represents an in-person programming and evaluation session for an implantable cardiac contractility modulation–defibrillation system. This code captures the clinician-led process of testing device function, adjusting programmable parameters, selecting optimal settings, and documenting findings. It is relevant nationally as the use of advanced implantable cardiac devices grows and payers refine coverage and payment for device programming and follow-up.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of service definitions, typical sites of care, and common billing considerations tied to device programming services. The publication highlights clinical context for why device optimization matters for patient outcomes and what elements are captured by the code description.
The report also outlines what to expect from payer coverage approaches and benchmarking topics: payment recognition for device interrogation and reprogramming sessions, documentation elements that support medical necessity, and how this service fits within outpatient device clinics and hospital-based device management. Data not available in the input will be noted where applicable, and the focus remains on national-level interpretation of the code’s clinical and billing intent.
Billing Code Overview
CPT code 0926T describes an in-person programming device evaluation for an implantable cardiac contractility modulation–defibrillation system. The session involves making device adjustments to test function, selecting optimal programmed values, and performing an analysis with a review and report of the findings.
Service type: Device programming and evaluation
Typical site of service: In-person, outpatient device clinic or hospital outpatient setting
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with heart failure and reduced ejection fraction presents for an in-person device programming and evaluation session after implantation of an implantable cardiac contractility modulation–defibrillation system. The patient is brought to an outpatient cardiac device clinic or hospital electrophysiology lab for a scheduled follow-up. The clinical workflow includes device interrogation using manufacturer programming hardware, review of recent arrhythmia logs and device diagnostics, noninvasive testing of therapy delivery, and on-table adjustments of programmed parameters to optimize contractility modulation outputs and defibrillation settings. A cardiologist or electrophysiologist supervises the session, a device clinic nurse or cardiac device specialist performs interrogations and measurements, and a device representative may assist with proprietary programming software. The encounter concludes with a documented analysis and a written report of findings, programming changes, and recommended follow-up timing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work required is substantially greater than typically required for a device programming visit due to complexity or complications |
26 | Professional component | For the physician’s interpretation and report when device company provides technical programming hardware/monitoring |
51 | Multiple procedures | When this device programming is billed on the same date as other distinct procedures requiring decrement per payer rules |
52 | Reduced services | If the programming session was partially completed or limited compared with the full service |
53 | Discontinued procedure | If the programming session was started but terminated for patient safety or other valid reason |
80 | Assistant surgeon | If an assistant surgeon is present and applicable under payer policy (rare for device programming) |
82 | Assistant surgeon (when qualified resident not available) | When assistant surgeon services meet payer criteria and no qualified resident is available |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare | When a qualifying nonphysician practitioner performs or assists in the service under Medicare rules |
TC | Technical component | When the facility bills the technical resources (equipment, device company telemetry) separately from the physician interpretation |
TG | Services furnished under a primary care exception | When applicable under employer-sponsored or other specific payer arrangements requiring TG |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RP0000X | Cardiology | Electrophysiology device implantation and follow-up, oversees programming and interpretation |
| 207RT0003X | Cardiac Electrophysiology | Subspecialty performing device interrogation, device optimization, and defibrillator function testing |
| 208D00000X | Internal Medicine | Hospitalists or cardiology consults who may coordinate outpatient device clinic visits |
| 363L00000X | Nurse Practitioner | Advanced practice providers who perform device interrogations and routine programming under supervision |
| 363A00000X | Physician Assistant | Commonly performs device checks and documents programming changes under supervising physician |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I50.22 | Chronic systolic (congestive) heart failure | Patients with reduced ejection fraction are common candidates for contractility modulation therapy and require device programming and optimization |
I50.32 | Chronic diastolic (congestive) heart failure | Diastolic dysfunction patients with device therapy adjustments for symptom management and arrhythmia monitoring |
I42.0 | Dilated cardiomyopathy | Underlying cardiomyopathy often coexists with indications for implantable contractility modulation and defibrillation devices |
I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris | Common comorbidity impacting overall device management and risk stratification |
I48.91 | Unspecified atrial fibrillation | Atrial arrhythmias frequently detected by device diagnostics and may require programming adjustments |
Z45.02 | Encounter for adjustment and management of implanted electronic cardiac device | Administrative code often used to indicate device management visits |
T82.XXA | Complications of cardiac device, initial encounter | Used if device-related complications prompt in-person programming evaluation |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
93290 | Programming device evaluation (in-person) with iterative adjustments and analysis for pacemaker, implantable cardioverter-defibrillator, or leadless pacemaker | Often used for non-CCM ICD/CRT devices; similar workflow for interrogation and iterative reprogramming when CCM-DF system coding is not applicable |
93291 | Interrogation device evaluation (remote) including analysis and report | Used for remote interrogations between in-person programming visits; complements an in-person 0926T visit |
93294 | Interrogation device evaluation with programming, in-person, for implanted electronic device | Alternative in-person programming code depending on device type and payer policy |
93288 | External/initial programming and analysis of cardiovascular device | Used for programming external components or during initial device setup visits in the electrophysiology lab |
93010 | Electrocardiogram, routine ECG with interpretation and report | Commonly performed before or after device programming to document rhythm and correlate to device therapy |
93255 | External or noninvasive programming and adjustment of implanted neurostimulator pulse generator system | Provided as a procedural analog in programming and analysis workflows for other implantable neuromodulation systems |