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See a sample rate comparisonCPT 93042 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Physician Report Of Ekg Test, Physician Interpretation And Report Of Electrocardiogram (Ecg Or Ekg) Heart Rhythm Test Results.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Cardiovascular Procedures |
| Common Place of Service | 23 - Emergency Room 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $7.01 national non-facility rate (2026) · View Medicare rates for 93042 |
| Medicaid Fee Schedule | $5.795 median of the 8 states in the free preview · View Medicaid rates for 93042 |
National average reimbursement for CPT 93042 by major payers:
$11.17
$9.87
$9.77
$11.41
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CPT 93042
5 of 25 sample ratesHigher to lower in this preview
Restorative Health Rehabilitation Inc
$40.00Published rateAnita Pairitz
Indiana University Health Southern Indiana Physicians
$14.38Published ratePeter Heydemann
Rush University Medical Center
$13.22Published rateJyoti Warikoo
Mount Sinai Community Foundation
$9.30Published rateJennifer Fulk
Town Center Orthopaedic Associates, P.C.
$6.95Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 93042 vs. Other Cardiovascular Procedures Codes
The CPT 93042 code is part of the Medicine Services and Procedures services used for Cardiovascular Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 93042 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 93040-CPT | Low | Physician Report Of Ekg Test, Physician Interpretation And Report Of Electrocardiogram (Ecg Or Ekg) Heart Rhythm Test Results. |
| 93041-CPT | Low | Rhythm Ecg 1-3 Leads; Tracing Only W/O Interpret & Rport, Rhythm Ecg 1-3 Leads; Tracing Only Without Interpretation And Report |
| 93042-CPT | Low | Physician Report Of Ekg Test, Physician Interpretation And Report Of Electrocardiogram (Ecg Or Ekg) Heart Rhythm Test Results. |
| 93227-CPT | Low | Wearable Electrocardiographic, Wearable Electrocardiographic Rhythm Derived Monitoring For 24 Hours By Continuous Original Waveformrecording And Storage With Visual Superimpositio N Scanning Physician Review And Interpretation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 93042. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 93042 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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