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See a sample rate comparisonCPT 93261 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Cardiovascular Procedures |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 26 - Professional component PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | $35.41 national non-facility rate (2026) · View Medicare rates for 93261 |
| Medicaid Fee Schedule | $56.53 median of the 8 states in the free preview · View Medicaid rates for 93261 |
National average reimbursement for CPT 93261 by major payers:
$88.44
$85.13
$90.96
$115.30
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CPT 93261
5 of 25 sample ratesHigher to lower in this preview
Malik Nassan
Head & Neck And Cosmetic Surgery Associates, LLC
$134.60Published rateRobert Hung
Northshore University Healthsystem Faculty Practice Associates
$92.98Published rateMatthew Niedzwiecki
$73.76Published rateMatthew Niedzwiecki
Loyola University Medical Center
$55.41Published rateMaria Fisfalen
Mount Sinai Community Foundation
$27.46Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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 |
| 93278-CPT | Low | Detailed Heart Test (Ekg), An Electrocardiogram (Ecg Or Ekg) Measures The Heart Rhythm Through Wires Attached To The Chest. Electric Signals From The Heart Are Measured Over A Period Of Time. |
| 93279-CPT | Low | Prgrmg Dev Eval Pm Ldls Pm, 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 Single Lead Pacemaker System Or Leadless Pacemaker System In One Cardiac Chamber |
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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