How much does Medicare pay for CPT 93291?

Medicare allowed an average of $42.95 per service and paid $32.70 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $176.92, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 93291?

Evaluation of cardiac rhythm monitor system. It was billed 42,183 times to 29,172 Medicare beneficiaries by 883 providers in 2024.

Does 93291 pay differently in an office than a hospital?

Yes. The allowed amount averaged $45.35 in an office setting and $16.98 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 93291 most?

Clinical Cardiac Electrophysiology, with 22,932 services from 429 clinicians. Next are Cardiology, Nurse Practitioner, Interventional Cardiology.

CPT 93291

Evaluation of cardiac rhythm monitor system

$42.95Medicare-allowed amount per service, averaged across 42,183 services

Providers submitted

$176.92

Asking price, not received

Medicare allowed

$42.95

The fee schedule figure

Medicare paid

$32.70

Balance is patient coinsurance

Providers submitted an average of $176.92 for this code and Medicare allowed $42.95 — 4.1× 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 $32.70 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $45.35
Hospital / facility: $16.98

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. 38,626 services were billed in an office setting and 3,557 in a facility.

Services: 42,183
Beneficiaries: 29,172
Providers billing it: 883
Total allowed: $1,811,760

What Medicare pays for CPT 93291

Across 42,183 services billed by 883 providers to 29,172 beneficiaries, Medicare allowed an average of $42.95 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 93291

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Cardiac Electrophysiology	22,932	16,428	$43.17	429
Cardiology	11,919	7,516	$44.42	273
Nurse Practitioner	3,283	2,579	$36.13	90
Interventional Cardiology	2,395	1,411	$45.47	40
Internal Medicine	691	432	$41.01	18
Physician Assistant	681	553	$35.48	22
Hospitalist	104	87	$48.52	3
Sleep Medicine	81	76	$46.55	3
Undefined Physician type	36	35	$51.06	2
Intensive Cardiac Rehabilitation	21	21	$54.93	1
Vascular Surgery	21	15	$16.73	1
Certified Clinical Nurse Specialist	19	19	$14.47	1

93291 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
New York	8,267	$51.11	$34.34	81
Florida	7,889	$43.79	$32.85	120
New Jersey	3,753	$50.70	$35.48	47
California	3,634	$49.10	$32.66	73
Texas	3,558	$36.52	$28.07	103
South Carolina	1,203	$42.33	$33.19	34
Arizona	1,161	$34.97	$27.52	26
Illinois	1,058	$41.61	$32.16	29
Georgia	1,013	$37.00	$30.94	28
North Carolina	927	$37.61	$31.52	23
Pennsylvania	805	$43.54	$31.75	33
Kansas	605	$35.21	$28.23	11
Arkansas	597	$24.38	$18.47	3
Ohio	564	$31.51	$24.44	21
West Virginia	562	$29.57	$23.58	13
Wisconsin	537	$31.19	$23.14	14
Virginia	493	$35.64	$25.93	22
Tennessee	477	$36.53	$30.05	21
Indiana	429	$31.85	$24.95	15
Mississippi	412	$40.14	$31.60	12
Oklahoma	365	$26.96	$22.27	15
Michigan	356	$41.15	$31.15	13
Missouri	344	$27.90	$21.43	10
Colorado	314	$37.42	$28.44	10
Nebraska	277	$43.99	$35.79	7
Louisiana	273	$32.01	$27.10	9
Washington	251	$44.03	$31.15	7
Maryland	247	$43.50	$28.92	11
Nevada	231	$38.62	$29.56	7
Massachusetts	197	$32.37	$23.32	9
Minnesota	187	$30.47	$24.80	8
Connecticut	173	$45.84	$30.80	7
Alabama	160	$39.95	$35.40	4
Kentucky	151	$30.59	$25.51	5
Wyoming	125	$48.14	$37.02	2
South Dakota	110	$27.61	$20.89	5
District of Columbia	73	$25.24	$19.43	4
Utah	71	$28.13	$22.69	3
North Dakota	66	$16.85	$12.90	3
Delaware	60	$22.49	$16.66	4
Iowa	59	$29.45	$24.07	3
Oregon	51	$51.28	$34.33	2
New Mexico	42	$16.48	$12.11	3
Vermont	23	$14.33	$9.55	1
New Hampshire	21	$16.72	$7.23	1
Idaho	12	$44.18	$35.16	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.