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 | Cardiovascular Monitoring Services 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 |
| Medicare Fee Schedule | View Medicare rates for 93261 |
National average reimbursement for CPT 93261 by major payers:
$88.44
$85.13
$90.96
$115.30
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 93261 | $43.56 | 1518037126 - MARY LAKE | 364187449 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 93261 | $84.30 | 1437492493 - ASHLEY MULVIHILL | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 93261 | $56.38 | 1760412621 - RHONDA LAMPEN | 910844563 | CA | Psychiatry Physician (2084P0800X) |
United | 93261 | $92.98 | 1770014920 - JOSEPH PEPITONE | 363738206 - NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES | VT | Psychiatry Physician (2084P0800X) |
United | 93261 | $134.60 | 1942650130 - MALIK NASSAN | 362679194 - (IL) HEAD & NECK AND COSMETIC SURGERY ASSOCIATES, LLC | MN | Psychiatry Physician (2084P0800X) |
United | 93261 | $29.13 | 1205975448 - CHRISTOPHER JOHNSON | 371158318 - (IL) SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $69.87 | 1902440969 - WANDA CEGERS | 362743287 - TCA HEALTH INC NFP | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $75.23 | 1760419311 - PETER HEYDEMANN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 93261 | $118.79 | 1992904197 - JOANNA BLACKBURN | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 93261 | $124.72 | 1376063370 - ABBY FREDRICKSON | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $80.94 | 1285715847 - SHANNON JENNINGS | 362604009 - (IL) OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER | CO | Psychiatry Physician (2084P0800X) |
United | 93261 | $27.46 | 1558354357 - MARIA FISFALEN | 363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $118.79 | 1891921367 - KAVITA THAKKAR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 93261 | $92.98 | 1770769432 - ROBERT HUNG | 363738206 - NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES | IL | Psychiatry Physician (2084P0800X) |
United | 93261 | $55.41 | 1174859284 - MATTHEW NIEDZWIECKI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | CA | 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 93261 vs. Other Cardiovascular Procedures Codes
The CPT 93261 code is part of the Cardiovascular Monitoring Services 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 Heart Recording, A Continuous Recording Of Heart Activity By An External Device. The Recording May Last From 8 To15 Days. The Full Procedure Includes Event Recording An Analysis With Report Review Of The Report And Interpretation Of Results. |
| 93246-CPT | Low | External Heart Recording, A Continuous Recording Of Heart Activity By An External Device. The Recording May Last From 8 To15 Days. The Full Procedure Includes Event Recording An Analysis With Report Review Of The Report And Interpretation Of Results. |
| 93260-CPT | Low | Prgrmg Dev Eval Impltbl Sys, Programming Device Evaluation In Person With Iterative Adjustment Of The Implantable Device To Test The Function Of The Device And Select Optimal Permanent Programmed Values With Analysis Review And Report By A Physician Or Other Qualified Health Care Professional Implantable Subcutaneous Lead Defibrillator System |
| 93261-CPT | Low | Cardioverter-Defib Analysis, Interrogation Device Evaluation (In Person) With Analysis Review And Report By A Physician Or Other Qualified Health Care Professional Includes Connection 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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