New CPT Codes for Cardiac Device Monitoring SIDE-BY-SIDE COMPARISON 2008-2009

New CPT Codes for Cardiac Device Monitoring SIDE-BY-SIDE COMPARISON 2008-2009 Effective January 1, 2009

NEW CPT 1 CODES FOR CARDIAC DEVICE MONITORING Twenty-three new CPT codes for Cardiac Device Monitoring were created by the American Medical Association in 2008 at the request of the American College of Cardiology and the Heart Rhythm Society. This booklet includes descriptive information on these new CPT codes which become effective January 1, 2009. This is not a comprehensive list of all new CPT codes and it is possible that there is a more appropriate code for any given procedure. Pages 3-9 provide a side-by-side comparison of the 2008 and 2009 CPT codes. Boldface type is used to highlight key words, providing a quick reference. A detailed listing of the 2008 CPT codes that will be deleted effective January 1, 2009 is on page 13. CPT code descriptor revisions that are effective January 1, 2009, such as external (wearable) electrocardiographic monitoring, are on page 14. The CPT code set has been developed as stand-alone descriptions of medical procedures. Some CPT procedure codes are not printed in their entirety but instead refer back to the common portion of the procedure listed in a preceding entry. This is apparent when an entry is followed by one or more indentations. Here is an example: 93279: Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; single lead pacemaker system 93280: dual lead pacemaker system These new cardiac device monitoring codes (pages 11-12): better describe services associated with implantable cardiac devices and recognize advances in cardiac monitoring technologies distinguish between a programming and an interrogation evaluation, in person or remote, as well as codes for multiple lead (more than two) device evaluations describe the work associated with assessment and programming of an implanted cardiac device pre- and post-procedure, surgery, or test report physiologic monitoring such as intrathoracic impedance, left atrial pressure, and weight and blood pressure obtained from internal and/or external sensors describe services associated with wearable mobile cardiovascular telemetry For questions or for more information, please contact Medtronic at 1 (866) 877-4102, option 1. Cardiac Rhythm Disease Management (CRDM) reimbursement customer information is available at www.medtronic.com/crdmreimbursement. CPT copyright 2008 American Medical Association. All rights reserved. 1

Additional Coding Information: Medtronic has prepared this document to reflect the current information provided in the Display Copy of the 2009 Final Rule for the Medicare Physician Fee Schedule. 2 It is important to refer to the new CPT code descriptions in order to ensure that a billed code meets the specific requirements defined for each individual code. Any time new procedure codes are implemented, there may be some ambiguity as to exact usage guidelines and/or applicability to very specific individual scenarios. You should contact your local contractor/payer for interpretation of applicable policies. Medtronic may periodically post updated versions of this document on its reimbursement website 3 as additional information becomes available. These new CPT codes were developed to more accurately reflect current cardiac device monitoring capabilities, long distance telemetry and remote interrogation network systems, and follow-up practices. Some of these new code sets are structured differently than the CPT codes that they replace. Specifically, the new codes for remote monitoring do not have separate professional (-26) and technical s (-TC) applied to an individual code. Instead, the new remote monitoring codes have separate CPT codes that represent the professional and technical s. The new device programming codes are generally defined by the number of leads, rather than the type of generator. Also, the period of time included in the specific type of service is indicated as per encounter, 30 or 90 days. There are two new peri-procedural device evaluation and programming codes: 93286 for pacemakers and 93287 for ICDs. These codes are used when performing an evaluation of an implantable device system to adjust the device settings appropriate for the patient prior to a surgery, procedure, or test. The device system data are interrogated to evaluate the lead(s), sensor(s), and battery in addition to review of stored information, including patient and system measurements. The device is programmed to settings appropriate for the surgery, procedure, or test, as required. A second evaluation and programming are performed after the surgery, procedure, or test to provide settings appropriate to the post-procedural situation, as required. Each instance of either pre- or post-evaluation and programming services may be reported. For CPT codes other than for remote monitoring, the Global CPT codes comprise the Professional and Technical Components. If both s of care are rendered, it is not necessary to append a modifier to the code. However, the remote monitoring codes are an example of a global service that requires two different CPT codes to be billed together as one code represents the Professional Service and another code represents the Technical Service (e.g., CPT 93294 & 93296, 93295 & 93296, 93297 & 93299, 93298 & 93299). The Professional Component reflects physician time and intensity in furnishing the service, including activities before and after direct patient contact. 4 When only the professional is performed, modifier 26 should be added to the appropriate CPT code to identify the service. The -26 modifier would not be appended if the code represents only the professional services of the CPT code description (e.g., CPT 93294, 93295, 93297, 93298). The Technical Component refers to the resources used in furnishing the service, such as office rent, wages of personnel, and other office practice expenses. When only the technical is performed, the modifier TC 5 should be added to the appropriate CPT code to identify the service. The -TC modifier would not be appended if the code represents only the technical support and services of the CPT code description (e.g., CPT 93296, 93299). Physician Supervision Requirements Medicare established specific diagnostic test supervision requirements applicable to the technical of the electronic analysis of implanted cardiac devices. 6 Medicare requires: General supervision of the technical service for remote pacemaker and ICD interrogations (codes 93296, 93299) Direct supervision of the technical for in person cardiac device interrogations Direct supervision for the technical of a transtelephonic pacemaker evaluation NOTE: Medicare specifies direct supervision for the professional service of a remote pacemaker interrogation (CPT 93294). Please contact your Medicare contractor to seek clarification on the difference in supervision requirements between this code and other device evaluation professional services. These supervision requirements are in addition to any other Medicare coverage requirements. The Medicare supervision requirements for individual CPT codes are available on the Physician Fee Schedule Lookup function on the Medicare website 7 or under PFS Relative Value Files for 2009. 8 General supervision 9 means the procedure is furnished under the physician s overall direction and control, but the physician s presence is not required during the performance of the procedure. Under general supervision, the training of the non-physician personnel who actually performs the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician. Direct supervision 9 means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed. The Heart Rhythm Society (HRS) has recently released a document that represents their consensus statement on the role of manufacturers representatives in the care of patients with heart rhythm disorders. This policy statement also contains HRS perspective on appropriate delivery of and billing for the technical of services associated with cardiac devices. 10 We encourage providers to seek confirmation or clarification from the payer about the policy statement. These coding suggestions do not replace seeking coding advice from the payer and/or your own coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service. For questions or for more information, please contact Medtronic at 1 (866) 877-4102, option 1. Cardiac Rhythm Disease Management (CRDM) reimbursement customer information is available at: www.medtronic.com/crdmreimbursement. 2

New CPT Codes for Cardiac Device Monitoring Effective January 1, 2009 Category 2008 CPT Code 2008 CPT Code Description 2009 CPT Code 2009 CPT Code Description Time Period Other Information IMPLANTABLE PACEMAKER Pacemaker In Person 93731, 93731-TC 6 or 93731-26 11 93734, 93734-TC or 93734-26 93735, 93735-TC or 93735-26 Electronic analysis of dual chamber pacemaker system (includes evaluation of programmable parameters at rest and without reprogramming Electronic analysis of single chamber pacemaker system (includes evaluation of programmable parameters at rest and without reprogramming with reprogramming 93288, 93288-TC or 93288-26 93279, 93279-TC or 93279-26 Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system (Do not report 93288 in conjunction with 93279-93281, 93286, 93294, 93296) Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; single lead pacemaker system (Do not report 93279 in conjunction with 93286, 93288) per encounter 93732, 93732-TC or 93732-26 Electronic analysis of dual chamber pacemaker system (includes evaluation of programmable parameters at rest and with reprogramming 93280, 93280-TC or 93280-26 93281, 93281-TC or 93281-26 dual lead pacemaker system (Do not report 93280 in conjunction with 93286, 93288) multiple lead pacemaker system (Do not report 93281 in conjunction with 93286, 93288) For example, three lead biventricular pacemaker 3

Pacemaker Remote 93731 12 -TC 93734 12 -TC Electronic analysis of dual chamber pacemaker system (includes evaluation of programmable parameters at rest and without reprogramming Electronic analysis of single chamber pacemaker system (includes evaluation of programmable parameters at rest and without reprogramming 93296 Interrogation device evaluation(s), (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable cardioverter-defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results (Do not report 93296 in conjunction with 93288, 93289, 93299) (Report 93296 only once per 90 days) 93296 represents the technical 93731 12-26 93734 12-26 Electronic analysis of dual chamber pacemaker system (includes evaluation of programmable parameters at rest and without reprogramming Electronic analysis of single chamber pacemaker system (includes evaluation of programmable parameters at rest and without reprogramming 93294 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim physician analysis, review(s) and report(s) (Do not report 93294 in conjunction with 93288, 93293) (Report 93294 only once per 90 days) per 90 days 93294 represents the professional 93731 12 or 93734 12 CPT code descriptions referenced above 93294 and 93296 CPT code descriptions referenced above Pacemaker Remote Interrogation Device Evaluation Global 6 Pacemaker Transtelephonic Monitoring 93733, 93733-TC or 93733-26 93736, 93736-TC or 93736-26 Electronic analysis of dual chamber internal pacemaker system (may include rate, pulse amplitude and duration, configuration of wave form, and/or testing of sensory function of pacemaker), telephonic analysis Electronic analysis of single chamber internal pacemaker system (may include rate, pulse amplitude and duration, configuration of wave form, and/or testing of sensory function of pacemaker), telephonic analysis 93293, 93293-TC or 93293-26 Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with physician analysis, review and report(s), up to 90 days (Do not report 93293 in conjunction with 93294) (For in person evaluation, see 93040, 93041, 93042) (Report 93293 only once per 90 days) per 90 days 4

Category 2008 CPT Code 2008 CPT Code Description 2009 CPT Code 2009 CPT Code Description Time Period Other Information IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR Defibrillator In Person 93741, 93741-TC or 93741-26 93743, 93743-TC or 93743-26 Electronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and single chamber or wearable cardioverter-defibrillator system, without reprogramming dual chamber, without reprogramming 93289, 93289-TC or 93289-26 Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead implantable cardioverter-defibrillator system, including analysis of heart rhythm derived data elements (For monitoring physiologic cardiovascular data elements derived from an ICD, use 93290) (Do not report 93289 in conjunction with 93282-93284, 93287, 93295, 93296) 93742, 93742-TC or 93742-26 single chamber or wearable cardioverter-defibrillator system, with reprogramming 93282, 93282-TC or 93282-26 Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; single lead implantable cardioverter-defibrillator system (Do not report 93282 in conjunction with 93287, 93289, 93745) per encounter 93744, 93744-TC or 93744-26 dual chamber, with reprogramming 93283, 93283-TC or 93283-26 93284, 93284-TC or 93284-26 dual lead implantable cardioverter-defibrillator system (Do not report 93283 in conjunction with 93287, 93289) multiple lead implantable cardioverter-defibrillator system (Do not report 93284 in conjunction with 93287, 93289) For example, three lead biventricular defibrillator Defibrillator Remote 93741 12 -TC Electronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and single chamber or wearable cardioverter-defibrillator system, without reprogramming 93743 12 -TC dual chamber, without reprogramming 93296 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable cardioverter-defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results (Do not report 93296 in conjunction with 93288, 93289, 93299) (Report 93296 only once per 90 days) per 90 days 93296 represents the technical 5

93741 12-26 single chamber or wearable cardioverter-defibrillator system, without reprogramming 93743 12-26 dual chamber, without reprogramming 93295 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable cardioverterdefibrillator system with interim physician analysis, review(s) and report(s) (For remote monitoring of physiologic cardiovascular data elements derived from an ICD, use 93297) (Do not report 93295 in conjunction with 93289) (Report 93295 only once per 90 days) 93295 represents the professional 93741 12 or 93743 12 CPT code descriptions referenced above 93295 and 93296 CPT code descriptions referenced above Defibrillator Remote Interrogation Device Evaluation Global 6 IMPLANTABLE CARDIOVASCULAR MONITOR (ICM) AND IMPLANTABLE LOOP RECORDER (ILR) Implantable Cardiovascular Monitor (ICM) In Person None Not Applicable 93290, 93290-TC or 93290-26 Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors per encounter (For heart rhythm derived data elements, use 93289) (Do not report 93290 in conjunction with 93297, 93299) Implantable Cardiovascular Monitor (ICM) Remote 93297 Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, physician analysis, review(s) and report(s) (For heart rhythm derived data elements, use 93295) (Do not report 93297 in conjunction with 93290, 93298) 93297 represents the professional of ICM (Report 93297 only once per 30 days) None Not Applicable 93299 implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results (Do not report 93299 in conjunction with 93290, 93291, 93296) per 30 days 93299 represents the technical of ICM (Report 93299 only once per 30 days) 93297 and 93299 CPT code descriptions referenced above ICM Remote Interrogation Device Evaluation Global 6 6

Category 2008 CPT Code 2008 CPT Code Description 2009 CPT Code 2009 CPT Code Description Time Period IMPLANTABLE CARDIOVASCULAR MONITOR (ICM) AND IMPLANTABLE LOOP RECORDER (ILR) (continued) Other Information Implantable Loop Recorder (ILR) In Person 93727 Electronic analysis of implantable loop recorder (ILR) system (includes retrieval of recorded and stored ECG data, physician review and interpretation of retrieved ECG data and reprogramming) 93291, 93291-TC or 93291-26 93285, 93285-TC or 93285-26 Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; implantable loop recorder system, including heart rhythm derived data analysis (Do not report 93291 in conjunction with 33282, 93288-93290, 93298, 93299) per Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; implantable loop recorder system (Do not report 93285 in conjunction with 33282, 93279, 93284, 93291) encounter Implantable Loop Recorder (ILR) Remote 93298 Interrogation device evaluation(s), (remote) up to 30 days; implantable loop recorder system, including analysis of recorded heart rhythm data, physician analysis, review(s) and report(s) (Do not report 93298 in conjunction with 93291, 93297) (Report 93298 only once per 30 days) 93298 represents the professional of ILR None Not Applicable 93299 implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results (Do not report 93299 in conjunction with 93290, 93291, 93296) (Report 93299 only once per 30 days) per 30 days 93299 represents the technical of ILR 93298 and 93299 CPT code descriptions referenced above ILR Remote Interrogation Device Evaluation Global 6 7

PERI-PROCEDURAL Peri-Procedural In Person Only None Not Applicable 93286, 93286-TC or 93286-26 93287, 93287-TC or 93287-26 Peri-procedural device evaluation and programming of device system parameters before or after a surgery, procedure, or test with physician analysis, review and report; single, dual, or multiple lead pacemaker system (Report 93286 once before and once after surgery, procedure, or test, when device evaluation and programming is performed before and after surgery, procedure, or test) (Do not report 93286 in conjunction with 93279-93281, 93288) single, dual, or multiple lead implantable cardioverter-defibrillator system (Report 93287 once before and once after surgery, procedure, or test, when device evaluation and programming is performed before and after surgery, procedure, or test) (Do not report 93287 in conjunction with 93282-93284, 93289) per encounter WEARABLE Mobile Cardiovascular Telemetry 93799 Unlisted cardiovascular service or procedure 93228 Wearable mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; physician review and interpretation with report per 30 days 93228 represents the professional (Report 93228 only once per 30 days) (Do not report 93228 in conjunction with 93014) 93799 Unlisted cardiovascular service or procedure 93229 technical support for connection and patient instructions for use, attended surveillance, analysis and physician prescribed transmission of daily and emergent data reports (Report 93229 only once per 30 days) (Do not report 93229 in conjunction with 93014) (For wearable cardiovascular monitors that do not perform automatic ECG triggered transmissions to an attended surveillance center, see 93224-93227, 93230-93272) per 30 days 93229 represents the technical 8

Category 2008 CPT Code 2008 CPT Code Description 2009 CPT Code 2009 CPT Code Description Time Period Other Information WEARABLE (continued) Wearable Cardioverter-Defibrillator 93745 Initial set-up and programming by a physician of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events 93745 Initial set-up and programming by a physician of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events (Do not report 93745 in conjunction with 93282, 93292) 93741, 93741-TC or 93741-26 93742, 93742-TC or 93742-26 Electronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and single chamber or wearable cardioverter-defibrillator system, without reprogramming single chamber or wearable cardioverter-defibrillator system, with reprogramming 93292, 93292-TC or 93292-26 Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; wearable defibrillator system (Do not report 93292 in conjunction with 93745) per encounter 9

NOTES 10

The following CPT codes are effective for services provided on and after January 1, 2009: 93228: Wearable mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; physician review and interpretation with report 93229: Wearable mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and physician prescribed transmission of daily and emergent data reports 93279: Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; single lead pacemaker system 93280: Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; dual lead pacemaker system 93281: Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; multiple lead pacemaker system 93282: Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; single lead implantable cardioverter-defibrillator system 93283: Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; dual lead implantable cardioverter-defibrillator system 93284: Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; multiple lead implantable cardioverter-defibrillator system 93285: Programming device evaluation with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; implantable loop recorder system 93286: Peri-procedural device evaluation and programming of device system parameters before or after a surgery, procedure, or test with physician analysis, review and report; single, dual, or multiple lead pacemaker system 93287: Peri-procedural device evaluation and programming of device system parameters before or after a surgery, procedure, or test with physician analysis, review and report; single, dual, or multiple lead implantable cardioverter-defibrillator system 93288: Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead pacemaker system 93289: Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; single, dual, or multiple lead implantable cardioverter-defibrillator system, including analysis of heart rhythm derived data elements 11

93290: Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors 93291: Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; implantable loop recorder system, including heart rhythm derived data analysis 93292: Interrogation device evaluation (in person) with physician analysis, review and report, includes connection, recording and disconnection per patient encounter; wearable defibrillator system 93293: Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with report(s), up to 90 days 93294: Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim physician analysis and physician review and report(s) 93295: Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable cardioverter-defibrillator system with interim physician analysis and physician review(s) and report(s) 93296: Interrogation device evaluation(s), (remote), up to 90 days; single, dual, or multiple lead pacemaker system or implantable cardioverter-defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results 93297: Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, physician analysis, review(s) and report(s) 93298: Interrogation device evaluation(s), (remote) up to 30 days; implantable loop recorder system, including analysis of recorded heart rhythm data, physician analysis, review(s) and report(s) 93299: Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular monitor system or implantable loop recorder system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results 12

The following CPT codes will be deleted as of January 1, 2009: 93727: Electronic analysis of implantable loop recorder (ILR) system (includes retrieval of recorded and stored ECG data, physician review and interpretation of retrieved ECG data and reprogramming) 93731: Electronic analysis of dual-chamber pacemaker system (includes evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic without reprogramming 93732: Electronic analysis of dual-chamber pacemaker system (includes evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic with reprogramming 93733: Electronic analysis of dual chamber internal pacemaker system (may include rate, pulse amplitude and duration, configuration of wave form, and/or testing of sensory function of pacemaker), telephonic analysis 93734: Electronic analysis of single chamber pacemaker system (includes evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic without reprogramming 93735: Electronic analysis of single chamber pacemaker system (includes evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic with reprogramming 93736: Electronic analysis of single chamber internal pacemaker system (may include rate, pulse amplitude and duration, configuration of wave form, and/or testing of sensory function of pacemaker), telephonic analysis 93741: Electronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and exercise, analysis of event markers and device response); single chamber or wearable cardioverter-defibrillator system, without reprogramming 93742: E lectronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and exercise, analysis of event markers and device response); single chamber or wearable cardioverter-defibrillator system, with reprogramming 93743: Electronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and exercise, analysis of event markers and device response); dual chamber, without reprogramming 93744: Electronic analysis of pacing cardioverter-defibrillator (includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and exercise, analysis of event markers and device response); dual chamber, with reprogramming 13

CPT codes with description revisions as of January 1, 2009: 93224: Wearable E electrocardiographic rhythm derived monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; includes recording, scanning analysis with report, physician review, and interpretation 93225: Wearable E electrocardiographic rhythm derived monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; recording (includes connection hook-up, recording, and disconnection) 93226: Wearable E electrocardiographic rhythm derived monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; scanning analysis with report 93227: Wearable E electrocardiographic rhythm derived monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; physician review and interpretation 93230: Wearable E electrocardiographic rhythm derived monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; includes recording, microprocessor-based analysis with report, physician review and interpretation 93231: Wearable E electrocardiographic rhythm derived monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; recording (includes connection hook-up, recording, and disconnection) 93232: Wearable E electrocardiographic rhythm derived monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; microprocessor-based analysis with report 93233: Wearable E electrocardiographic rhythm derived monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; physician review and interpretation 14

References 1 CPT copyright 2008 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. 2 http://www.cms.hhs.gov/physicianfeesched/pfsfrn/list.asp#topofpage. 3 www.medtronic.com/crdmreimbursement. 4 Social Security Act Section 1848(c) (1) (A) and (B). 5 Section 410.32(b) of the Code of Federal Regulations (CFR). 6 http://www.cms.hhs.gov/physicianfeesched/pfsfrn/list.asp#topofpage. pages 1159-1164. 7 Medicare s website is: http://www.cms.hhs.gov/pfslookup/02_pfssearch.asp 8 http://www.cms.hhs.gov/physicianfeesched/pfsfrn/list.asp#topofpage. 9 Medicare Benefit Policy Manual, CMS-Pub. 100-02, Chapter 15, 80. http://www.cms.hhs.gov/manuals/iom/list.asp 10 Lindsay BD, Estes NA III, Maloney JD, Reynolds DW. Heart Rhythm Society Policy Statement Update: Recommendations on the Role of Industry Employed Allied Professionals (IEAPs). Heart Rhythm. November 2008;5(11):e8-10. 11 Modifier 26: Professional Component, per the American Medical Association. 12 CMS-Pub. 100-104: Medicare Claims Processing. Transmittal 979, Change Request 5048, June 9, 2006. This transmittal can be found at http://www.cms.hhs.gov/transmittals/downloads/r979cp.pdf. www.medtronic.com World Headquarters Medtronic, Inc. 710 Medtronic Parkway Minneapolis, MN 55432-5604 USA Tel: (763) 514-4000 Fax: (763) 514-4879 Medtronic USA, Inc. Toll-free: 1 (800) 328-2518 (24-hour technical support for physicians and medical professionals) UC200900783 EN Medtronic, Inc. 2008. Minneapolis, MN. All Rights Reserved. Printed in USA. 11/2008