CPT code 93750 – LVAD interrogation billing guide

Key takeaways

CPT code 93750 reports an in-person interrogation of a ventricular assist device, with analysis, any programming, and a written report.

A remote or telephone VAD review is not reportable as 93750, and CPT has no remote VAD interrogation code to use instead.

Programming done during the session is part of 93750, so it never goes on the claim as a separate line.

A same-day E/M visit needs its own documented reason, with modifier 25 appended to the E/M code.

Medicare pays 93750 as a whole service with no 26/TC split, at 1.59 RVUs in the office and 1.02 in a facility for 2026.

CPT code 93750: Official descriptor and clinical scope

CPT code 93750 reports an in-person interrogation of a ventricular assist device (VAD), with analysis by a physician or other qualified health care professional. The key phrase is in person. The clinician reviews device parameters and function with the patient present, programs the device if needed, and writes a report.

One unit of 93750 covers the whole encounter. That includes analysis of device parameters such as drivelines, alarms, and power surges. It also includes review of device function, such as flow and volume status, septum status, and recovery. Programming is part of the code when it happens, so a separate programming charge for the same session duplicates the service.

The official AMA descriptor is long, so the table below breaks it into its parts, word for word.

What ventricular assist device interrogation includes and excludes

Coders sometimes bill 93750 for remote monitoring sessions, or for E/M visits where a brief device check happened to occur. Both create audit exposure. The table below separates what the code covers from what needs a different code or no separate billing at all.

Documentation requirements for CPT 93750

Documentation is where most 93750 claims fail on audit. A clean claim submission for this code rests on a written interrogation report that covers each item below, whether or not a parameter changed.

• Device identification: Manufacturer, model, and serial number.
• All parameters reviewed: Pump speed (RPM), power consumption, pulsatility index, flow estimate, and alarm settings. Record every one, not only those adjusted.
• Device functions assessed: Driveline condition, battery status, controller integrity, and any active alarms or alerts.
• Programming changes made: State explicitly if no changes were made. “Device settings unchanged” is acceptable and necessary.
• Clinical interpretation: The physician’s or qualified clinician’s assessment of the findings and their clinical significance.
• Patient response or status: At minimum, a note on how the patient tolerated the encounter.
• Date and time of the face-to-face encounter.

The report does not need to be a separate paper form. A structured note in the patient record that covers every item above satisfies the requirement. What fails audit is a note that records only the final pump speed, with no reference to the other parameters reviewed. Generating a superbill only after the full report is complete keeps the claim from going out early.

Modifiers for CPT code 93750

Modifier choice for CPT code 93750 is narrower than for most cardiology codes. The code has no professional/technical split, so the decisions sit with a same-day E/M visit and with NCCI edits.

CMS treats XE, XS, XP, and XU as more specific versions of modifier 59, and some Medicare Administrative Contractors expect them. Check your MAC’s guidance before you default to 59. Keep both off the E/M line, where modifier 25 does the job.

Related CPT codes and how 93750 differs

LVAD teams bill across a cluster of codes, depending on the device and the setting. Confusing in-person with remote interrogation is a frequent audit finding, and the map below sorts each encounter to the code it takes.

Remote ICD follow-up runs on a 90-day reporting period under 93295, a structure VAD follow-up does not have. Every code in the map has its full descriptor in the CPT code library, so check the wording before you switch codes.

Medicare reimbursement for CPT 93750

Medicare pays CPT code 93750 under the CMS Physician Fee Schedule. The 2026 national relative value units (RVUs) below come from the October 2026 PFS relative value file. Local payment then shifts with the Geographic Practice Cost Index (GPCI) for your locality.

93750 carries PC/TC indicator 0. It is a physician service with no professional/technical split, so modifiers 26 and TC do not apply. The practitioner bills the whole code in either setting, and the place of service decides which rate applies.

Two conversion factors apply in 2026. Qualifying APM participants are paid at $33.5675 per RVU and other clinicians at $33.4009, which explains the paired dollar figures. The facility rate is lower because the hospital bills its own practice costs to Medicare separately.

Prior authorization and payer requirements for 93750

Medicare does not currently require prior authorization for CPT code 93750 as a routine billing condition, though annual rule updates can change that. Commercial payers vary considerably. Some treat the interrogation as a standard cardiology service with no pre-auth requirement. Others require authorization above a set number of visits per year, or when the encounter happens in a hospital outpatient setting.

Running insurance eligibility verification at each visit catches payer-specific authorization rules before the claim is submitted. The common pre-auth triggers to watch for across commercial payers include:

• More than 4 in-person VAD interrogations in a calendar year per patient
• Services billed with a hospital outpatient place of service (19 or 22) rather than 11 (office)
• Patients with Medicaid managed care plans, which often layer additional requirements on top of the base Medicaid benefit
• New LVAD implants within the first 30-90 days post-surgery, where some payers require a notification or concurrent review

Document the specific reason for each interrogation visit in the medical record. When a payer requests records for a prior authorization decision, “post-speed-adjustment follow-up” is more defensible than a generic “routine LVAD check.” Clear visit reasons also support medical billing compliance and cut the number of authorization appeals your team handles.

Common claim denial reasons and how to avoid them

LVAD interrogation claims fail for a narrow set of repeatable reasons. The table below maps each denial type for CPT code 93750 to its root cause and the fix that stops it recurring.

Structured denial management workflows sort each 93750 denial by root cause. Your team can then fix the documentation or workflow problem behind a pattern, instead of reworking each denial one at a time.

How Pabau supports LVAD interrogation billing

LVAD programs hit a timing problem with this code. The interrogation report must be complete before the claim goes out, but clinicians often finish it after the patient leaves. Claims sent early go out with missing parameters, the wrong place of service, or no modifier on the E/M line.

Pabau, the practice management platform we build, keeps the interrogation note and the claim on the same patient record. Its claims management software connects to the Claim.MD clearinghouse for US practices. Your team can check eligibility, submit 837P claims, track claim status, and post ERA remittances without leaving the record.

The practical rule is to hold the 93750 charge until the clinician signs the interrogation note. A claim built from a signed, complete report is far less likely to come back for missing documentation. You also know whether it cleared before the patient’s next interrogation visit.

Manage LVAD billing claims without the paperwork chase

Pabau’s claims management connects to the Claim.MD clearinghouse to submit CPT claims, check eligibility, and track claim status from the patient record. Book a demo to see how cardiology billing teams use it.

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Conclusion

Treat 93750 as a narrow code and build the workflow around that. Bill it only when someone checked the device face to face and wrote a report, and keep remote reviews off the claim.

The biggest payoff sits in the interrogation template. A template that forces every parameter field, unchanged ones included, prevents most documentation denials. Pair it with a place-of-service check at charge entry, and the office-versus-facility rate takes care of itself.

Book a demo to see how Pabau keeps the interrogation note and the 93750 claim on one patient record.

Continue your research

Need a clearinghouse for electronic CPT claims? Pabau’s Claim.MD clearinghouse guide explains how the integration handles 837P submission and ERA remittance for US practices.

Want to reduce denials across your billing operation? Denial codes in medical billing covers CARC reason codes and how to map them to root-cause fixes in your workflow.

Billing the VAD insertion as well? CPT code 33990 covers percutaneous ventricular assist device insertion, the procedure that often comes before ongoing interrogations.

Billing cardiac procedures alongside other services? Revenue cycle management for practices outlines how to build a clean-claim process from eligibility through payment posting.

Frequently asked questions