Summary & Overview
CPT 93286: Pacemaker Evaluation and Parameter Optimization
CPT code 93286 covers face‑to‑face evaluation and optimal adjustment of an existing pacemaker system (single, dual, multiple‑lead, or leadless) performed before, during, and/or just after a procedure, including review of results and report preparation. The code bundles both professional and technical components when performed by a physician or other qualified healthcare professional. Nationally, this code captures a common intra‑procedural device management task that affects perioperative workflow, device-related quality measurement, and billing for electrophysiology and procedural cardiology services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and payment across these payers influence access to timely device adjustments during procedures and impact hospital and ambulatory surgery center billing practices.
Readers will find a concise explanation of what CPT code 93286 represents, the clinical contexts where it is used, and which payers typically cover the service. The publication provides benchmarks for coding and billing components, notes common modifiers used with the service, and outlines operational considerations for procedure‑based pacemaker management. Where input data is missing, the report states that the information is not available in the input.
Billing Code Overview
CPT code 93286 describes a service in which a physician or other qualified healthcare professional performs a face–to–face evaluation and then optimally adjusts the existing parameters of a single, dual, multiple–lead, or leadless pacemaker system before, during, and/or just after a procedure, reviews the results, and prepares a report. This service represents both the professional and technical components performed by a qualified provider.
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Service type: Device programming and intra‑procedural pacemaker evaluation with parameter optimization
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Typical site of service: Hospital or ambulatory procedural setting where a pacemaker is being interrogated and adjusted around a procedure
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 74-year-old male with a history of symptomatic bradycardia and a previously implanted dual-lead pacemaker presents on the day of a scheduled electrophysiology-guided generator replacement. The patient undergoes a face-to-face evaluation by the electrophysiologist prior to the procedure to review symptoms, recent device interrogations, and current medications. During the generator change, the physician connects to the existing pacemaker system, assesses sensing and pacing thresholds for both atrial and ventricular leads, and optimally adjusts device parameters (programming rate, output, sensitivity, AV delays, and mode settings) before, during, and immediately after the procedure to ensure adequate capture and appropriate sensing. The clinician documents baseline measurements, adjustments made, intraoperative testing (including lead impedance and threshold testing), and post-adjustment device interrogation results, then prepares a formal report. Typical site of service is an outpatient surgical center or hospital operating/recovery area where monitored invasive device procedures are performed. The service reflects both professional and technical components provided by the physician or qualified healthcare professional performing the programming and evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician’s professional interpretation and report are billed separate from the device clinic or hospital technical component |