CPT 93243 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Cardiovascular Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 93243 by major payers:
$237.33
$70.99
$167.31
$397.11
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 93243 | ||||||
United | 93243 | $81.20 | 1184815870 - RYAN COATES | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 93243 | $75.69 | 1144267865 - NITIN PATEL | 364143823 - SIU PHYSICIANS & SURGEONS INC | MO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 93243 | $69.47 | 1669598421 - CHANDRIKA SHANKAR | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 93243 | $51.88 | 1255534483 - SHALINI CHAWLA | 274089658 - (IL) SHALINI CHAWLA MD LLC | IL | Psychiatry Physician (2084P0800X) |
United | 93243 | $51.88 | 1306474986 - MELVIN JOSEPH | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 93243 | $78.08 | 1033347125 - DAVID HANRAHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MN | Psychiatry Physician (2084P0800X) |
United | 93243 | $74.79 | 1679540595 - JOSEPH MCNALLY | 461186809 - (IL) MCNALLY AND GARA PSYCHIATRIC SOLUTIONS LLC | IL | Psychiatry Physician (2084P0800X) |
United | 93243 | $64.75 | 1679968697 - JEREMIAH BREWER | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | WI | Psychiatry Physician (2084P0800X) |
United | 93243 | $95.25 | 1831335850 - CLAUDINE SINSIOCO | 540620889 - INOVA HEALTH CARE SERVICES | IL | Psychiatry Physician (2084P0800X) |
United | 93243 | $100.80 | 1104230036 - AFSANEH TALAI | 756002868 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 93243 | $64.75 | 1760412621 - RHONDA LAMPEN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | CA | Psychiatry Physician (2084P0800X) |
United | 93243 | $77.44 | 1730263617 - MARK ALTER | 811324691 | CA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 93243 | $100.58 | 1558997593 - CYRIL APPIAGYEI | 363097297 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 93243 | $76.75 | 1336431667 - SURAYA KAWADRY | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | FL | Psychiatry Physician (2084P0800X) |
United | 93243 | $66.58 | 1700895257 - LARA SEGALITE | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 93243 vs. Other Cardiovascular Procedures Codes
The CPT 93243 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 93243 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 |
|---|---|---|
| 93017-CPT | Low | Cardiovascular Stress Test Using Maximal Or Submaximal Treadmill Or Bicycle Exercise, Continuous Electrocardiographic Monitoring, And/Or Pharmacological Stress; Tracing Only, Without Interpretation And Report |
| 93241-CPT | Moderate | External Electrocardiographic Recording For More Than 48 Hours Up To 7 Days By Continuous Rhythm Recording And Storage; Includes Recording Scanning Analysis With Report Review And Interpretation |
| 93242-CPT | Low | External Electrocardiographic Recording For More Than 48 Hours Up To 7 Days By Continuous Rhythm Recording And Storage; Recording (Includes Connection And Initial Recording) |
| 93243-CPT | Moderate | External Electrocardiographic Recording For More Than 48 Hours Up To 7 Days By Continuous Rhythm Recording And Storage; Scanning Analysis With Report |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 93243. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 93243 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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