How much does Medicare pay for CPT 93609?

Medicare allowed an average of $269.78 per service and paid $215.21 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1150.72, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 93609?

Insertion of tube in upper and/or lower heart chambers to record and identify origin of abnormal heart rhythm. It was billed 6,659 times to 6,472 Medicare beneficiaries by 152 providers in 2024.

Does 93609 pay differently in an office than a hospital?

Yes. The allowed amount averaged $270.03 in an office setting and $269.78 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 93609 most?

Clinical Cardiac Electrophysiology, with 5,645 services from 120 clinicians. Next are Cardiology, Internal Medicine, Interventional Cardiology.

CPT 93609

Insertion of tube in upper and/or lower heart chambers to record and identify origin of abnormal heart rhythm

$269.78Medicare-allowed amount per service, averaged across 6,659 services

Providers submitted

$1150.72

Asking price, not received

Medicare allowed

$269.78

The fee schedule figure

Medicare paid

$215.21

Balance is patient coinsurance

Providers submitted an average of $1150.72 for this code and Medicare allowed $269.78 — 4.3× 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 $215.21 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $270.03
Hospital / facility: $269.78

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. 11 services were billed in an office setting and 6,648 in a facility.

Services: 6,659
Beneficiaries: 6,472
Providers billing it: 152
Total allowed: $1,796,465

What Medicare pays for CPT 93609

Across 6,659 services billed by 152 providers to 6,472 beneficiaries, Medicare allowed an average of $269.78 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 93609

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Cardiac Electrophysiology	5,645	5,485	$269.74	120
Cardiology	861	837	$271.00	27
Internal Medicine	131	130	$261.53	4
Interventional Cardiology	22	20	$282.77	1

93609 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	1,811	$267.32	$204.20	31
Florida	1,029	$280.89	$206.46	14
New York	775	$307.73	$206.25	16
Texas	501	$259.91	$207.11	19
Arizona	207	$254.28	$206.53	6
Virginia	197	$251.74	$206.52	4
Massachusetts	191	$265.99	$206.68	5
West Virginia	190	$254.23	$206.62	4
Georgia	177	$253.56	$207.41	6
North Carolina	166	$243.81	$206.64	5
New Jersey	144	$309.15	$206.90	4
Illinois	136	$276.20	$207.60	5
Washington	133	$276.26	$206.25	2
Oklahoma	106	$252.70	$207.29	1
Idaho	103	$234.94	$206.80	2
Oregon	97	$213.61	$206.23	3
Indiana	85	$238.09	$206.36	2
Michigan	70	$275.71	$207.17	3
South Dakota	65	$245.75	$206.33	2
Louisiana	63	$256.19	$207.08	1
South Carolina	58	$254.86	$207.15	2
Pennsylvania	57	$271.08	$206.60	2
Maryland	50	$285.60	$206.07	2
Kansas	44	$238.01	$205.73	1
Tennessee	42	$238.67	$207.78	3
Mississippi	33	$238.48	$207.78	1
Connecticut	31	$275.48	$206.31	1
Ohio	28	$255.16	$205.39	1
Iowa	25	$237.33	$206.95	1
District of Columbia	19	$252.55	$206.78	1
Kentucky	15	$248.20	$206.96	1
Missouri	11	$249.43	$206.34	1

Related codes

93656Comprehensive electrophysiologic evaluation$911.22
93657Destruction of tissue of upper heart chamber through tube to treat abn$297.38
93655Insertion of catheters and destruction of tissue to treat abnormal hea$294.16
93623Programming of heart rhythm stimulation after drug infusion$65.91
93662Ultrasound evaluation of heart blood vessel$67.91
93653Comprehensive electrophysiologic evaluation$804.30
93622Insertion of catheters for recording and pacing of left lower heart ch$163.00
93650Destruction of heart conduction tissue to create heart block$527.25
93660Evaluation of heart function$111.98
93641Evaluation of single or dual chamber pacing cardioverter-defibrillator$156.53
93654Comprehensive electrophysiologic evaluation$954.56
93620Insertion of catheters for recording and pacing of right heart chamber$595.77

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.