Summary & Overview
CPT 0931T: Electrophysiologic Evaluation of CCM–Defibrillation System Leads
CPT code 0931T represents a specialized diagnostic electrophysiology procedure that evaluates the leads and defibrillation efficacy of a cardiac contractility modulation–defibrillation system when performed separately from implantation or replacement. This code is relevant nationally as use of implantable cardiac modulation and combined device therapies expands, and as payers and providers seek consistent billing for lead testing and defibrillation-threshold assessment.
Key payers included in the coverage analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and the procedure scope, typical sites of service, commonly associated modifiers, and payer coverage patterns. The publication also summarizes benchmarks and policy updates affecting billing and reimbursement for electrophysiology lead evaluation services, outlines clinical context for arrhythmia induction and defibrillation testing, and highlights coding considerations for separate, post-implant evaluations.
This summary is designed for clinicians, coding professionals, and policy analysts seeking a concise reference on CPT code 0931T, its clinical role, and payer treatment at the national level. Data not available in the input is noted where detailed payer-specific rates, taxonomies, ICD-10 pairings, and related codes would normally appear.
Billing Code Overview
CPT code 0931T describes an electrophysiologic evaluation of the leads of a cardiac contractility modulation–defibrillation system, performed separately from initial implantation or replacement. The procedure includes defibrillation-threshold evaluation, induction of arrhythmia, and evaluation of sensing and therapy for arrhythmia termination.
Service type: Diagnostic electrophysiology procedure focused on implanted cardiac contractility modulation–defibrillation system lead performance and defibrillation efficacy
Typical site of service: Hospital-based cardiac electrophysiology lab or cardiac catheterization/electrophysiology procedural suite
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with ischemic cardiomyopathy and persistent heart failure with reduced ejection fraction (LVEF 30%) presents for evaluation of his previously implanted cardiac contractility modulation–defibrillation (CCM‑DF) system because of recurrent symptomatic ventricular arrhythmias and concerns about lead performance. The patient arrives to the electrophysiology lab on an outpatient basis under monitored anesthesia care. Pre-procedure evaluation includes device interrogation, review of recent device diagnostics, and assessment of antiarrhythmic medications. The provider performs an electrophysiologic evaluation of the CCM‑DF leads separate from implantation or replacement. The procedure includes induction of arrhythmia (usually with programmed electrical stimulation), defibrillation‑threshold (DFT) testing if indicated, assessment of sensing thresholds, lead impedance, and evaluation of therapy delivery during arrhythmia termination. Intra-procedural monitoring includes continuous ECG, invasive arterial blood pressure as needed, and readiness for external defibrillation. Post‑procedure, device parameters are reprogrammed as necessary, the patient is observed for hemodynamic stability and wound complications, and device interrogation data are documented in the chart. Typical site of service is an electrophysiology laboratory or cardiac catheterization lab within an ambulatory surgery center or hospital outpatient setting. Typical billing reflects a standalone procedure performed separate from initial implantation or generator replacement, reported with procedure code 0931T.
Coding Specifications
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