Cardiology Billing Guide: 2026 CPT Codes, Modifiers and NCCI Rules

• Access, monitoring and fluoroscopy are inside the procedure. Cath, PCI, EP and device codes include them (NCCI ch. XI §I.4, §I.15, §I.20).
• One PCI code per major coronary artery, plus at most two recognized branches, each identified with a coronary modifier (§I.14).
• Stress tests include the IV, the drug infusion and the ECG strips, and an E/M on the same day needs modifier 25 and its own documentation (§I.9–10).
• Echo contrast injections are never separate; contrast echo in a hospital outpatient department uses C8921–C8930 (§I.23).
• Ambulatory ECG codes are chosen by duration, and Florida Medicare wants the reason for monitoring past 24 hours in the record (A59270).

The federal updates that touch a cardiology claim this year, stated only as CMS published them.

The American College of Cardiology tracks coding and payment changes for its members in its Coding and Reimbursement resources (read November 9, 2026).

A stress test is one of the most-billed services in cardiology and one of the easiest to over-bill, because several separately coded services happen during it. NCCI chapter XI §I.10 says the test includes insertion of the needle or catheter, the infusion or injection used for a pharmacologic test, and the ECG strips. Codes 36000, 36410, 96360–96379, 93000–93010 and 93040–93042 are not reported in addition.

• The visit in the stress lab is part of the test. A history and limited exam related to the test are included. An E/M for a significant, separately identifiable problem is reported with modifier 25 (§I.9).
• MTWA is a different test. Microvolt T-wave alternans (93025) uses a submaximal protocol; 93015–93018 are not reported for it or on the same date (§I.11).
• Stress echo is coded in the echo family, 93350 or 93351, with add-on 93352 for contrast (§I.23).

Transthoracic studies are 93306, 93307 and 93308, which is how Medicare contractors list them in their billing articles (for example Wellpoint Federal’s A56781, Transthoracic Echocardiography). The NCCI rules that apply across the echo family:

The same Wellpoint article sets the documentation bar most contractors share: a contrast study needs a record showing the conventional study was inconclusive, every study needs a formal written report, and repeat studies should be driven by a change in clinical status. Florida’s contractor publishes its own policies, so check First Coast’s before relying on another region’s.

Catheterization (93451–93461) and PCI codes are comprehensive. NCCI §I.15 lists what they already include: needle and catheter insertion (36000, 36140, 36160, 36200–36248, 36410), infusion (96360–96379), fluoroscopy (76000) and ECG rhythm strips (93040–93042), plus any ultrasound guidance. ECG tracings taken during the procedure for chest pain are included; a diagnostic ECG before or after it may be reported with modifier 59 or XU (§I.16).

How PCI is counted

Coronary modifiers

Diagnostic angiography on the day of the PCI

• Catheter placement is included. Device procedures (33202–33275) and EP procedures (93600–93662) are not billed with cardiac or selective catheterization codes for placing their catheters, or with fluoroscopy 76000 or ultrasound guidance. A cath that is a distinct, necessary service may be reported (§I.20).
• Recording and pacing during device insertion are included. 93600, 93602, 93603, 93610 and 93612 are integral to inserting or replacing an electrode or device. A limited diagnostic EP study done first to decide whether to proceed may be reported with a PTP-associated modifier (§I.22).
• Cardioversion includes ICD interrogation and programming (93282–93284, 93289, 93292, 93295 are not added to 92960 or 92961), and analysis of an antitachycardia pacemaker (93724) includes pacemaker interrogation and programming (93279–93281, 93286, 93288) (§I.27–28).
• Internal cardioversion 92961 is a “separate procedure” and is not paid with a cath or PCI through the same access (§I.29).
• 93623 is an add-on only to 93610, 93612, 93619, 93620 or 93653–93656, and is not reported for drug testing after an ablation to confirm it worked (§I.30).

First Coast, the Medicare contractor for Florida, covers ambulatory ECG monitoring under LCD L39492 and lists the codes in billing article A59270 (revision R6, effective October 1, 2026). The monitor must be FDA-cleared and prescribed; smartphone and wrist-worn devices are not covered. A 24–48 hour monitor is the expected choice for daily or near-daily symptoms, and the duration should match the symptoms.

What A59270 wants in the record: the diagnosis or clinical suspicion that led to monitoring, documented medical necessity for monitoring beyond 24 hours and for the monitor type chosen, and the interpretation with the interpreting physician’s name. Noridian’s billing page (updated July 11, 2025) adds a national point: monitoring codes are billed in sets, sets cannot be completed within 29 days of each other, the claims system checks overlaps across all Part A and B claims nationwide, and there are no appeal rights for those denials.

Critical care (99291, 99292) is reported by time, and time spent on separately reportable procedures does not count toward it (§I.2). CPR without other E/M is 92950 alone; emergency defibrillation is included in CPR and is never 92960, which describes a planned elective cardioversion (§I.1, §I.3). Routine rhythm monitoring and review of hemodynamics are part of critical care; rhythm strips are added only for a sudden change in status (§I.13). Swan-Ganz placement (93503) is not billed with a central line code for one catheter, or with the confirming chest x-ray (§I.25–26).

Cardiac rehabilitation (93797, 93798) includes everything needed for the session. An E/M is reported only when significant and separately identifiable, with modifier 25 (§I.6). Medical nutrition therapy (97802–97804) at the same encounter is included, and PT or OT at the same encounter is part of the rehab benefit; at a separate, necessary encounter the same day they may be reported with a PTP-associated modifier (§I.7–8).

Each rule above becomes a denial when it is missed. The ones this guide covers: an add-on or component service billed with a comprehensive code that already includes it (an NCCI procedure-to-procedure edit), a second PCI line with no coronary modifier, a same-day E/M with modifier 25 but no separate documentation, a monitoring set that overlaps another provider’s set inside 29 days, and a monitor longer than 24 hours with no stated reason. Every one of these is fixed in the note or at coding, before the claim is sent. How a denied claim gets worked once it comes back is covered on our denial management page.

• Medicare NCCI Policy Manual 2026, Chapter XI: Medicine, §I Cardiovascular Services (revision date January 1, 2026; read November 9, 2026)
• Medicare NCCI Policy Manual 2026, Chapter I: General Correct Coding Policies, §E Modifiers (read November 9, 2026)
• CMS fact sheet: CY 2026 Medicare Physician Fee Schedule final rule (CMS-1832-F) (October 31, 2025)
• SCAI, General Coding Guidelines for PCI (November 2025 update; read November 9, 2026)
• First Coast Service Options, LCD L39492: Ambulatory Electrocardiograph (AECG) Monitoring (effective June 11, 2023; read November 9, 2026)
• First Coast Service Options, Billing and Coding article A59270: AECG Monitoring (revision R6, effective October 1, 2026)
• Noridian JE, Electrocardiographic Monitoring Services Billing (updated July 11, 2025)
• Wellpoint Federal, Billing and Coding article A56781: Transthoracic Echocardiography (revision effective October 1, 2026)
• CMS MLN907166, Global Surgery (December 2025)
• American College of Cardiology, Coding and Reimbursement (member resource; read November 9, 2026)

CPT codes and descriptors are from the AMA CPT code set. This guide does not state fee amounts; check your Medicare contractor’s fee schedule and your payer contracts.

Can an E/M visit be billed on the same day as a stress test?

Only when it is significant and separately identifiable. The 2026 NCCI manual says a history and limited exam related to the stress test are part of the test. An E/M for a separate problem, documented as such, is reported with modifier 25.

What is bundled into a cardiac stress test?

NCCI chapter XI says stress tests include the needle or catheter insertion, the infusion or injection for a pharmacologic test, and the ECG strips. Codes such as 36000, 36410, 96360–96379, 93000–93010 and 93040–93042 are not reported separately with 93015–93018.

How many PCI codes can be billed for one coronary artery?

One base code per major coronary artery through the native circulation, for all lesions in that artery. Up to two recognized branches of the LAD, circumflex and right coronary artery may each take one code; a third branch may not be reported. The left main and ramus intermedius have no recognized branches.

Which modifiers identify the coronary artery on a PCI claim?

LC for the left circumflex, LD for the left anterior descending, LM for the left main, RC for the right coronary artery and RI for the ramus intermedius. CMS lists them as NCCI anatomic modifiers, and the SCAI coding guide maps each to its branches.

Can diagnostic angiography be billed with a PCI on the same day?

Yes, when it is medically necessary and precedes the intervention. SCAI describes the usual cases: no prior study is available and the decision to intervene is based on the angiogram, or the prior study is inadequate or the clinical picture has changed. Fluoroscopy is never billed separately with catheterization.

Is contrast billed separately with an echocardiogram?

The injection is not. NCCI chapter XI says IV push injections of contrast during echocardiography are not separately reportable. In stress echo, add-on 93352 reports contrast use with 93350 or 93351. Hospital outpatient claims use HCPCS C8921–C8930 for contrast echo instead of the CPT code.

How do I bill a Holter or event monitor in Florida?

First Coast, the Florida Medicare contractor, groups the codes by monitoring length: 93224–93227 up to 48 hours, 93241–93248 over 48 hours to 15 days, 93268–93272 for event monitors and 93228–93229 for mobile telemetry, reported once per 30 days. Monitoring beyond 24 hours needs documented medical necessity.

Is a device interrogation billable with a cardioversion?

No. NCCI says cardioversion includes interrogation and programming of an implantable defibrillator if performed, so codes such as 93282–93284, 93289, 93292 and 93295 are not reported with 92960 or 92961.

What changed for cardiology billing in 2026?

The 2026 NCCI Policy Manual took effect January 1, 2026. The CY 2026 Physician Fee Schedule final rule set conversion factors of $33.57 and $33.40 and applied a -2.5% efficiency adjustment to non-time-based services, which includes cardiac tests and procedures. E/M visits are exempt.