Current Procedural Terminology (CPT) codes form a standardized language used throughout the United States healthcare system to describe medical services and procedures for billing purposes. An Electrocardiogram (EKG or ECG) is a common diagnostic test that measures the heart’s electrical activity, providing a tracing of the rhythmic impulses that signal heartbeats. These codes ensure that healthcare providers are accurately reimbursed by payers, like insurance companies, for the specific services rendered. The CPT codes are maintained and copyrighted by the American Medical Association (AMA).
Standard Resting EKG Codes
The standard 12-lead resting electrocardiogram uses a specific set of three CPT codes in the 93000 series. CPT code 93000 is the “global” code for a complete service. This code encompasses the entire service: the technical act of performing the tracing, the professional interpretation by a qualified healthcare professional, and the final written report. This code is used when a single provider or facility performs and bills for all aspects of the test.
When the service is split—for example, performed in an emergency room and interpreted later by a cardiologist—two distinct codes are used. CPT code 93005 reports only the technical component, which involves patient preparation, lead application, equipment use, and the physical recording of the tracing. This code covers the costs associated with the equipment, supplies, and the clinical staff who perform the test.
The professional component is billed using CPT code 93010. This code covers the physician’s or qualified healthcare professional’s work, including the expert interpretation of the heart’s electrical patterns and the creation of the final report. When 93005 and 93010 are billed separately, the combined reimbursement should equal the rate for the global code (93000).
Continuous and Extended Monitoring Codes
When a patient requires monitoring of the heart’s rhythm over an extended period, a separate set of CPT codes are used compared to a single resting EKG. Holter monitoring is a common form of continuous monitoring, typically involving a portable device recording the heart’s activity for 24 to 48 hours. The global code for this service is CPT code 93224, which includes all aspects from the device application to the final interpretation.
When the Holter monitoring service is unbundled, the codes are split into three parts:
- CPT code 93225 covers the recording component, encompassing the connection, initial recording, and disconnection of the monitor.
- CPT code 93226 is for the scanning analysis and report generation of the extensive data.
- CPT code 93227 covers the final professional review and interpretation of the analyzed Holter data.
Longer-term monitoring, such as Mobile Cardiac Outpatient Telemetry (MCOT), is necessary when symptoms are infrequent, sometimes requiring monitoring for up to 30 days. This technology often includes concurrent, real-time data analysis and remote surveillance. CPT code 93229 represents the technical component for MCOT, covering the equipment, attended surveillance, connection, and transmission of data. CPT code 93228 is used for the professional component, which is the physician’s review and interpretation of the data, sometimes over a period up to 30 days.
Professional and Technical Components
The distinction between the Professional Component (PC) and the Technical Component (TC) is a fundamental concept in billing for diagnostic services, including EKGs. The Technical Component covers the non-physician costs associated with performing the procedure. This includes the depreciation and maintenance of the equipment, the supplies used, such as electrodes and gel, and the compensation for the technical staff who set up and monitor the test. In a hospital setting, the facility typically bills for the Technical Component.
The Professional Component represents the intellectual work and medical judgment provided by the physician or qualified healthcare professional. This includes the supervision of the procedure, the thorough analysis and interpretation of the recorded data, and the final documentation in a formal, written report. The physician’s expertise in reading the heart’s electrical signals is what the Professional Component compensates. This PC is typically billed by the physician group or the professional entity.
For the standard resting EKG, the three codes (93000, 93005, 93010) are designed to explicitly define the global, technical-only, or professional-only service. When the EKG is performed in one location and the tracing is sent elsewhere for expert reading, the service must be split using the respective component-only codes.
Modifiers for EKG Services
CPT modifiers are two-digit codes appended to a primary CPT code to indicate that the service or procedure has been altered by specific circumstances but its basic definition remains unchanged. These modifiers are crucial for accurate reimbursement, especially when a procedure is split between a facility and a physician.
Modifier 26 is used to identify that only the Professional Component of a service is being billed. When a CPT code normally represents both the technical and professional work, appending Modifier 26 signals that the claim is only for the physician’s interpretation and report.
Conversely, the modifier TC (Technical Component) is used when a provider is billing only for the equipment, supplies, and technical staff involved in performing the procedure. This modifier is typically used by the hospital or non-physician entity that owns the diagnostic equipment. While these modifiers are widely applicable in diagnostic testing like radiology or certain stress tests, they are generally not used with the resting EKG codes (93000 series) because those services already have specific codes (93005 and 93010) that explicitly define the components.
However, the modifiers become relevant when billing for other diagnostic procedures that do not have dedicated component codes. Another common modifier is Modifier 59, which is used to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day.