Coding for Subcutaneous Cardiac Rhythm Monitors

On Nov. 2, 2020, the American Medical Association (AMA) CPT® Editorial Panel announced the approval of a new Category III CPT® code to describe remote programming of subcutaneous cardiac rhythm monitors. The new code will be effective July 1, 2021. Please note that the existence of a Category III CPT® code does not guarantee payment.

Category III codes are ‘temporary codes for emerging technology, services, procedures, and service paradigm,’ according to AMA’s CPT® Professional 2021 codebook. Payers generally do not cover such services, so these codes are primarily for reporting purposes only.

0650T Code Description

0650T: Programming device evaluation (remote) of subcutaneous cardiac rhythm monitor system with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review, and report by a physician or other qualified health care professional.

Subcutaneous Cardiac Rhythm Monitors

Subcutaneous cardiac rhythm monitors, also known as implantable loop recorders or insertable cardiac monitors, are indicated for adults at risk of developing an abnormal heart rhythm or have symptoms that may suggest a cardiac arrhythmia such as dizziness, palpitations, syncope, chest pain, and/or shortness of breath.

Subcutaneous cardiac rhythm monitors address an otherwise unmet clinical need through uninterrupted, long-term cardiac monitoring for patients with symptoms which recur too infrequently to be detected by shorter-term external monitoring modalities.

Within the context of the current COVID-19 pandemic where remote monitoring has become essential for device/patient surveillance, the newly added capability for remote programming improves patient care while mitigating the unnecessary exposure risk with in-person clinic/emergency department/hospital visits. Coverage for remote programming of these devices would facilitate clinical decision-making between physicians and their patients while also avoiding the costs with in-person clinic office visits.

Coding Guidelines

• The programming evaluation of a subcutaneous cardiac rhythm monitor system may be performed in person or remotely. Codes 93285, 0650T are reported per procedure.
• Remote programming device evaluation (0650T) includes in-person device programming (93285), when performed, on the same day.
• Programming device evaluation includes all components of the interrogation device evaluation. Therefore, 93291 (in-person interrogation) should not be reported in conjunction with 93285, 0650T.
• Programming device evaluations (93285, 0650T) and remote interrogation device evaluations (93298) may both be reported during the 30- day remote interrogation device evaluation period.
• Do not report 0650T in conjunction with codes 33285, 93260, 93279, 93280, 93281, 93282, 93284, 93285, 93291.
• These types of monitors have been covered by Medicare since 2004 under the Centers for Medicare and Medicaid Services (CMS) National Coverage Determination for Electrocardiographic Services (20.15), and remote interrogation device evaluation of these devices has been covered by Medicare since the creation of Category I CPT codes in 2009.

Functioning of Device

• Patient-activated and automatically recorded rhythm episodes are reviewed for evidence of accurately identified arrhythmias. Current data measurements are compared to stored and trended historical data.
• Device function is assessed for underlying signal strength and battery longevity. Sensing thresholds for detecting arrhythmias are evaluated and adjusted until optimized. The appropriate rhythm alerts are identified, and recording parameters are reviewed and adjusted.
• Total device memory capacity and parameters for recording capacity are reviewed. The amount of episode detection recording time is assessed and adjusted as needed to optimize the recording function.
• After a detailed evaluation of all parameters, a decision is made about the adequacy of the currently programmed parameters, and any identified device programming changes to optimize device performance are made and saved in the remote monitoring system.