How much does Medicare pay for CPT 93243?

Medicare allowed an average of $279.98 per service and paid $215.84 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1562.30, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 93243?

Heart rhythm analysis and report of continous external ekg over more than 48 hours up to 7 days. It was billed 254,806 times to 247,430 Medicare beneficiaries by 64 providers in 2024.

Which specialty bills 93243 most?

Independent Diagnostic Testing Facility (IDTF), with 253,422 services from 28 clinicians. Next are Cardiology, Interventional Cardiology, Clinical Cardiac Electrophysiology.

CPT 93243

Heart rhythm analysis and report of continous external ekg over more than 48 hours up to 7 days

$279.98Medicare-allowed amount per service, averaged across 254,806 services

Providers submitted

$1562.30

Asking price, not received

Medicare allowed

$279.98

The fee schedule figure

Medicare paid

$215.84

Balance is patient coinsurance

Providers submitted an average of $1562.30 for this code and Medicare allowed $279.98 — 5.6× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $215.84 (77%); the rest is the patient’s coinsurance and deductible.

Services: 254,806
Beneficiaries: 247,430
Providers billing it: 64
Total allowed: $71,340,584

What Medicare pays for CPT 93243

Across 254,806 services billed by 64 providers to 247,430 beneficiaries, Medicare allowed an average of $279.98 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 93243

Specialty	Services	Beneficiaries	Avg allowed	Providers
Independent Diagnostic Testing Facility (IDTF)	253,422	246,085	$280.50	28
Cardiology	918	888	$194.26	21
Interventional Cardiology	360	354	$170.02	9
Clinical Cardiac Electrophysiology	61	59	$190.07	3
Internal Medicine	34	33	$103.51	2
Family Practice	11	11	$229.32	1

93243 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	145,146	$296.65	$167.51	11
Texas	40,416	$296.99	$166.05	14
Pennsylvania	38,252	$241.43	$169.81	1
Illinois	24,034	$224.35	$170.44	4
New Jersey	4,181	$250.06	$164.88	2
Maryland	831	$259.97	$173.34	5
Louisiana	407	$180.85	$172.83	8
Georgia	360	$217.62	$168.24	1
Ohio	225	$201.15	$168.12	1
Wyoming	184	$218.39	$174.08	1
Tennessee	172	$196.20	$157.76	1
North Carolina	163	$201.99	$172.54	5
Florida	142	$192.08	$168.52	2
Oregon	111	$242.05	$174.49	1
Kansas	83	$179.76	$172.87	1
Massachusetts	38	$236.19	$158.03	2
Virginia	17	$215.47	$175.12	1
Kentucky	17	$0.01	$0.01	1
New York	15	$260.53	$172.83	1
Arkansas	12	$186.65	$131.74	1

Related codes

93296Evaluation of single$21.59
93294Evaluation of single$28.57
93298Evaluation of cardiac rhythm monitor system$76.45
93297Evaluation of implantable heart and blood vessel monitoring system$45.47
93280Programming of dual lead pacemaker system$61.84
93295Evaluation of single$35.37
93229Electrocardiogram (ecg) up to 30 days continuous$1018.21
93247Heart rhythm analysis and report of continous external ekg over 8-15 d$299.31
93248Heart rhythm review and interpretation of continous external ekg over$24.98
93228Electrocardiogram (ecg) up to 30 days continuous$24.32
93244Heart rhythm review$22.39
93284Programming of multiple lead implantable defibrillator system$85.19

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.