Summary & Overview
CPT 93642: Evaluation and Reprogramming of Pacemaker-Defibrillator System
CPT code 93642 denotes the professional service of evaluating and reprogramming the electrophysiologic and therapeutic settings of a single- or dual-chamber pacing defibrillator system. This code captures clinician time and expertise spent interrogating implanted cardioverter-defibrillators (ICDs) or cardiac resynchronization devices to review stored data, assess lead function, evaluate arrhythmia events, and modify pacing or shock parameters. Nationally, accurate coding for device interrogation and reprogramming affects quality reporting, device surveillance, and payment for cardiology outpatient services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis outlines how these payers commonly cover device interrogation and reprogramming services, and highlights typical sites of care where the service is provided.
Readers will gain a concise clinical and billing overview of CPT code 93642, understand where the service is typically delivered, and see what benchmarks and policy-related topics are most relevant for device clinic operations and coding compliance. Data not available in the input for modifiers, associated taxonomies, ICD-10 diagnoses, and related codes is noted for separate reference.
Billing Code Overview
CPT code 93642 describes the evaluation and reprogramming of electrophysiologic and therapeutic parameters for a single- or dual-chamber pacing defibrillator system. This procedure involves interrogation of the implanted device, assessment of pacing and defibrillation functions, review of stored electrograms and event logs, and adjustment of programming to optimize therapy delivery.
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Service type: Device reprogramming and electrophysiologic evaluation
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Typical site of service: Cardiology clinic, device clinic, hospital outpatient department, or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with a history of ischemic cardiomyopathy and a dual-chamber implantable cardioverter‑defibrillator (ICD) presents for routine device follow-up and for symptoms of intermittent presyncope. Interrogation of the device is performed in an outpatient electrophysiology clinic or device clinic by a cardiologist or cardiac electrophysiologist. The clinician connects the programmer to the ICD, reviews stored electrograms and therapy logs, assesses battery status, lead impedances, sensing and capture thresholds, and reviews arrhythmia episodes. Reprogramming is performed to adjust pacing modes, rate response settings, tachycardia detection and therapy zones, and antitachycardia pacing parameters to optimize therapy and reduce inappropriate shocks. The service is typically billed when the provider personally evaluates the device parameters and makes changes to the electrophysiologic and therapeutic settings of a single‑ or dual‑chamber pacing defibrillator system. Typical sites of service include an outpatient hospital clinic, hospital-based cardiac electrophysiology lab, ambulatory surgical center when performed as part of a device clinic visit, or inpatient hospital ward when performed during a hospital admission for device‑related issues.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician's interpretation and programming component separate from technical services |