First Coast Publishes Rates for New External Electrocardiographic Recording Codes

In late 2020, CMS announced that it would be moving from the temporary Category III codes for long term ECG monitoring and will instead use Category I CPT codes, starting January of 2021. CMS did not add national rates for the codes but is instead looking to the MACs to price individually.

There has been much attention on the initial Novitas proposed rates as they were a substantial reduction and impacted well known providers in the space. There was some movement on April 10^th when Novitas increased the initial rate; however there is still a large delta between the previous Category III rates and the rates announced April 10^th. Bruce Quinn has been covering CMS changes and “policy vacillations” around digital health codes in his Discoveries in Health Policy blog and has some great information about this, including an analysis of specific codes.

So far, the only other MAC that has published the rates for the new 2021 CPT codes is First Coast. These rates look to be more positive for providers in that jurisdiction (Florida, Puerto Rico, US Virgin Islands). 

Previous Codes and Rates by MAC

With all jurisdictions, the continuous cardiac monitoring and detection replacement codes 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248 have replaced the Category III codes 0295T, 0296T, 0297T, and 0298T, which were deleted. While the codes are not a one-to-one match, the pricing that is retroactive starting January 1, 2021 for Novitas and First Coast appears to be a very mixed bag for providers in this space. Please see the table to the right for the rates that have been published so far along with rates for the deleted Category III codes. As other MACs announce rates, we will update the table.

Transitioning from Category III to Category I

93241: External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation formerly 0295T.

*Revised 2021 contractor-priced reimbursement rates for new external electrocardiographic recording codes. Source: First Coast

• Deleted code: 0295T External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation crosswalk to 93241 or 93245

93242: External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; recording (includes connection and initial recording) formerly 0296T.

• Deleted code: 0296T recording (includes connection and initial recording) Crosswalk to 93242 or 93246

93243: External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; scanning analysis with report formerly 0297T.

• Deleted code: 0297T scanning analysis with report Crosswalk to 93243 or 93247

93244: External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; review and interpretation formerly 0298T.

• Deleted code: 0298T review and interpretation Crosswalk to 93244 or 93248

93245: External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; includes recording.

• Deleted code: 0295T External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation crosswalk to 93241 or 93245

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