How much does Medicare pay for CPT 93290?

Medicare allowed an average of $38.38 per service and paid $28.75 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $117.31, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 93290?

Evaluation of implantable heart and blood vessel monitoring system. It was billed 63,509 times to 45,963 Medicare beneficiaries by 1,063 providers in 2024.

Does 93290 pay differently in an office than a hospital?

Yes. The allowed amount averaged $40.68 in an office setting and $19.32 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 93290 most?

Clinical Cardiac Electrophysiology, with 29,256 services from 386 clinicians. Next are Cardiology, Nurse Practitioner, Interventional Cardiology.

CPT 93290

Evaluation of implantable heart and blood vessel monitoring system

$38.38Medicare-allowed amount per service, averaged across 63,509 services

Providers submitted

$117.31

Asking price, not received

Medicare allowed

$38.38

The fee schedule figure

Medicare paid

$28.75

Balance is patient coinsurance

Providers submitted an average of $117.31 for this code and Medicare allowed $38.38 — 3.1× 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 $28.75 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $40.68
Hospital / facility: $19.32

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 56,675 services were billed in an office setting and 6,834 in a facility.

Services: 63,509
Beneficiaries: 45,963
Providers billing it: 1,063
Total allowed: $2,437,475

What Medicare pays for CPT 93290

Across 63,509 services billed by 1,063 providers to 45,963 beneficiaries, Medicare allowed an average of $38.38 per service. That is 1.4 services per beneficiary, so this is a code patients typically receive more than once. 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 93290

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Cardiac Electrophysiology	29,256	21,946	$37.47	386
Cardiology	23,115	15,344	$42.26	442
Nurse Practitioner	5,030	3,847	$29.64	88
Interventional Cardiology	2,003	1,538	$39.93	69
Physician Assistant	1,901	1,553	$28.45	33
Internal Medicine	1,062	792	$34.05	21
Advanced Heart Failure and Transplant Cardiology	727	600	$40.88	13
Certified Clinical Nurse Specialist	133	93	$35.19	3
Hospitalist	85	78	$41.70	2
Undefined Physician type	78	73	$41.63	1
Emergency Medicine	44	36	$41.89	1
Pediatric Medicine	33	25	$21.00	2
Cardiac Surgery	24	21	$41.53	1
Nuclear Medicine	18	17	$46.53	1

93290 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	7,816	$45.44	$30.77	131
Florida	7,453	$41.37	$31.12	138
New York	5,658	$40.16	$28.44	108
Texas	4,173	$35.54	$26.78	70
New Jersey	3,568	$47.96	$32.91	40
Maryland	3,264	$48.08	$33.88	44
Arkansas	2,650	$24.63	$19.98	45
Virginia	2,645	$24.59	$18.00	37
Ohio	2,323	$36.02	$27.89	37
Kansas	2,258	$32.19	$25.23	33
Tennessee	1,943	$32.44	$24.97	27
Pennsylvania	1,762	$43.99	$32.72	34
North Carolina	1,720	$33.61	$26.15	20
Massachusetts	1,692	$35.66	$25.04	19
Georgia	1,484	$37.26	$30.29	20
Michigan	1,339	$33.79	$25.45	28
Missouri	1,236	$32.29	$25.01	32
Nevada	1,183	$43.94	$32.72	12
Kentucky	1,160	$30.45	$23.23	19
Illinois	1,025	$43.11	$31.56	17
Indiana	837	$32.23	$24.62	13
Connecticut	658	$48.56	$32.69	16
South Carolina	559	$31.65	$25.11	18
Delaware	533	$38.54	$28.33	12
Mississippi	481	$28.63	$23.18	10
Nebraska	443	$39.36	$32.50	6
Arizona	414	$27.47	$20.40	11
West Virginia	390	$37.57	$31.02	5
Louisiana	326	$41.55	$34.28	9
District of Columbia	322	$49.31	$30.82	5
Oklahoma	312	$31.45	$25.04	4
Wisconsin	275	$37.55	$27.48	5
New Hampshire	266	$18.83	$13.60	2
Rhode Island	242	$22.76	$15.84	6
Idaho	237	$25.38	$19.85	4
Colorado	205	$41.86	$31.95	7
Minnesota	201	$37.95	$28.28	9
Utah	142	$33.64	$26.31	2
Oregon	88	$42.05	$33.65	2
New Mexico	75	$17.67	$12.57	1
Hawaii	62	$51.83	$36.19	2
Puerto Rico	55	$42.80	$31.61	2
Alabama	34	$39.78	$35.11	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
93243Heart rhythm analysis and report of continous external ekg over more t$279.98
93244Heart rhythm review$22.39

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.