How much does Medicare pay for CPT 93295?

Medicare allowed an average of $35.37 per service and paid $25.25 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $186.69, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 93295?

Evaluation of single, dual, or multiple lead implantable defibrillator system, remote up to 90 days. It was billed 695,160 times to 340,031 Medicare beneficiaries by 4,992 providers in 2024.

Does 93295 pay differently in an office than a hospital?

Yes. The allowed amount averaged $35.52 in an office setting and $34.91 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 93295 most?

Clinical Cardiac Electrophysiology, with 415,058 services from 2,006 clinicians. Next are Cardiology, Nurse Practitioner, Interventional Cardiology.

CPT 93295

Evaluation of single, dual, or multiple lead implantable defibrillator system, remote up to 90 days

$35.37Medicare-allowed amount per service, averaged across 695,160 services

Providers submitted

$186.69

Asking price, not received

Medicare allowed

$35.37

The fee schedule figure

Medicare paid

$25.25

Balance is patient coinsurance

Providers submitted an average of $186.69 for this code and Medicare allowed $35.37 — 5.3× 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 $25.25 (71%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $35.52
Hospital / facility: $34.91

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. 528,712 services were billed in an office setting and 166,448 in a facility.

Services: 695,160
Beneficiaries: 340,031
Providers billing it: 4,992
Total allowed: $24,587,809

What Medicare pays for CPT 93295

Across 695,160 services billed by 4,992 providers to 340,031 beneficiaries, Medicare allowed an average of $35.37 per service. That is 2.0 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 93295

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Cardiac Electrophysiology	415,058	201,663	$35.60	2,006
Cardiology	203,056	96,783	$35.64	2,181
Nurse Practitioner	24,309	15,173	$30.94	194
Interventional Cardiology	23,396	10,028	$35.29	375
Internal Medicine	15,208	8,029	$35.30	131
Physician Assistant	9,341	5,706	$31.31	61
Advanced Heart Failure and Transplant Cardiology	990	465	$35.27	12
Cardiac Surgery	983	526	$34.56	7
Critical Care (Intensivists)	542	197	$35.71	2
Hospitalist	519	406	$35.46	7
Certified Clinical Nurse Specialist	433	325	$30.23	4
Undefined Physician type	324	237	$36.24	3
Family Practice	299	140	$34.67	1
Independent Diagnostic Testing Facility (IDTF)	178	108	$37.27	1
Emergency Medicine	155	49	$34.79	1

93295 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
Florida	47,104	$36.13	$25.98	453
Texas	44,459	$34.99	$25.39	315
California	41,081	$37.40	$25.60	457
Pennsylvania	39,472	$35.43	$25.02	264
New York	37,186	$38.23	$25.40	279
Illinois	30,736	$36.59	$24.92	176
Ohio	29,113	$34.62	$24.88	199
Virginia	25,303	$35.78	$25.19	123
North Carolina	23,719	$34.30	$25.31	128
Tennessee	21,158	$33.77	$24.98	107
New Jersey	20,984	$38.22	$25.60	127
Georgia	20,618	$35.20	$24.96	116
Massachusetts	20,167	$36.25	$24.22	151
Indiana	18,785	$33.68	$24.62	98
South Carolina	18,677	$34.53	$25.82	97
Missouri	17,729	$34.33	$24.04	145
Michigan	17,464	$35.16	$23.91	154
Arizona	16,852	$34.68	$25.83	115
Maryland	13,940	$36.76	$25.30	91
Washington	13,727	$36.25	$24.83	87
Minnesota	11,807	$34.55	$23.61	72
Wisconsin	11,782	$33.94	$24.64	92
Kansas	11,708	$33.85	$25.86	86
Alabama	11,071	$33.25	$24.67	97
Kentucky	10,691	$34.54	$24.57	86
Louisiana	10,624	$34.12	$24.93	103
Oklahoma	10,578	$33.31	$24.96	68
Arkansas	9,757	$32.51	$24.90	58
Iowa	9,649	$32.81	$24.19	56
Colorado	9,019	$35.60	$24.85	73
Oregon	7,058	$35.49	$24.51	58
Connecticut	6,998	$35.67	$24.11	65
Nebraska	6,754	$32.99	$24.21	36
Mississippi	6,175	$33.63	$25.16	54
West Virginia	5,615	$35.09	$25.11	27
Delaware	3,993	$33.73	$23.77	32
Utah	3,576	$34.52	$25.15	22
New Hampshire	3,526	$34.73	$24.21	35
Montana	3,203	$35.26	$24.28	16
Nevada	3,108	$34.83	$25.16	32
South Dakota	3,006	$34.09	$23.56	13
North Dakota	2,551	$34.70	$24.47	16
New Mexico	2,545	$34.37	$24.92	16
Idaho	2,467	$33.87	$24.37	20
Maine	2,442	$35.37	$24.10	17
Alaska	2,116	$40.68	$21.06	8
District of Columbia	1,407	$37.89	$25.22	12
Rhode Island	1,289	$36.09	$25.48	9
Vermont	1,242	$34.47	$24.10	13
Hawaii	644	$34.34	$25.00	9
Wyoming	485	$31.69	$21.39	9

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
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
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.