CPT 93261 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 • 26 - Professional component • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
National average reimbursement for CPT 93261 by major payers:
$88.44
$85.13
$90.96
$117.48
| 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 93261 | ||||||
United | 93261 | $103.05 | 1386755486 - DOUGLAS NORDLI | 205521741 - SOUTHERN ILLINOIS MEDICAL SERVICES NFP | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 93261 | $33.29 | 1932216702 - ANAND KUMAR | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $34.02 | 1679968697 - JEREMIAH BREWER | 910843135 | TX | Psychiatry Physician (2084P0800X) |
United | 93261 | $29.14 | 1427387893 - ALAN HIRSCH | 872717056 - (IL) TOP MEDICAL CONSULTANTS PC | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $25.18 | 1144420365 - ALMA RAMIC | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $117.19 | 1447365440 - AYAME TAKAHASHI | 364143823 - SIU PHYSICIANS & SURGEONS INC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 93261 | $131.97 | 1962431726 - MARTINS ADEOYE | 432081789 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 93261 | $56.38 | 1730263617 - MARK ALTER | 910844563 | WI | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 93261 | $32.93 | 1699752394 - DAVID LOTT | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $46.47 | 1033117007 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 93261 | $124.72 | 1376063370 - ABBY FREDRICKSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $74.30 | 1326465436 - MUSADDIQ TARIQ | 510064318 - BAYHEALTH MEDICAL CENTER INC | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $109.23 | 1477181071 - KEVIN VARGHESE | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $33.91 | 1770014920 - JOSEPH PEPITONE | 363738206 - NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $49.52 | 1679739395 - BETSY OSTRANDER | 810232124 - SCL HEALTH MONTANA | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
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 93261 vs. Other Cardiovascular Procedures Codes
The CPT 93261 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 93261 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 |
|---|---|---|
| 93245-CPT | Moderate | External Electrocardiographic Recording For More Than 7 Days Up To 15 Days By Continuous Rhythm Recording And Storage; Includes Recording Scanning Analysis With Report Review And Interpretation |
| 93246-CPT | Low | External Electrocardiographic Recording For More Than 7 Days Up To 15 Days By Continuous Rhythm Recording And Storage; Recording (Includes Connection And Initial Recording) |
| 93260-CPT | Low | Programming Device Evaluation (In Person) With Iterative Adjustment Of The Implantable Device To Test The Function Of The Device And Select Optimalpermanent Programmed Values With Analysis Review And Report By A Physician Or Other Qualified Health Care Professional; Implantable Subcutaneouslead Defibrillator System |
| 93261-CPT | Low | Interrogation Device Evaluation (In Person) With Analysis Review And Report By A Physician Or Other Qualified Health Care Professional Includesconnection Recording And Disconnection Per Patient Encounter; Implantable Subcutaneous Lead Defibrillator System |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 93261. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 93261 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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