2026 Cardiac Telemetry CPT 93228 & 93229 Compliance Guide

Last updated: February 4, 2026

Key Takeaways

1. CMS 2026 rules increase audits on CPT 93228 and 93229, with denial rates reaching 40% from weak documentation and frequency violations.
2. Code 93228 covers physician review and interpretation. Code 93229 covers technical surveillance. Both apply once per 30 days with real-time data and more than 24 hours of ECG storage.
3. MCOT telemetry works best for infrequent symptoms, while Holter monitoring covers 24 to 48 hours with no real-time data, and event monitors rely on patient activation.
4. Core compliance requirements include physician orders, ICD-10 codes such as R55 syncope, daily logs, and avoiding dual Holter and MCOT billing that can cause $200 to $400 losses per case.
5. Rhythm360’s vendor-neutral platform automates compliance across OEMs. Schedule a demo to increase reimbursements and cut denials.

CPT Codes 93228 & 93229: Definitions, Limits, and 2026 Billing Rules

Precise definitions and billing rules for cardiac telemetry monitoring codes protect compliance and revenue.

Mobile cardiovascular telemetry involves external devices with electrocardiographic recording, concurrent computerized real-time data analysis, and greater than 24 hours of accessible ECG data storage with transmission to a remote attended surveillance center. The CMS Medicare Coverage Database specifies that providers should bill 1 unit of procedure code 93228 and/or 93229 per monitoring episode. Both codes apply only once per 30-day service period, and extra claims within that episode are not separately reportable.

MCOT vs Holter vs Event Monitoring: Choosing the Right Modality

Mobile cardiac outpatient telemetry (MCOT) functions as a distinct monitoring category with unique billing codes and clinical use cases.

MCOT delivers real-time continuous heart rhythm monitoring with transmission to a central station, while Holter monitoring lacks real-time capabilities and stops at 48 hours. MCOT involves real-time telemetry with continuous measurement, extended memory, and transmission to an attended center for up to 30 days. Current trends show rapid growth of AI-enabled RPM platforms that pull data from multiple OEMs and replace fragmented vendor portals that slow billing teams.

Schedule a demo to see how automated cardiac telemetry monitoring compliance can streamline your billing workflows.

93228 & 93229 Compliance Playbook: Checklists and Documentation

Strong CPT 93228 and 93229 billing rests on precise documentation, clear medical necessity, and payer-specific rules that prevent denials.

Essential Billing Checklist for Telemetry Claims

1. Physician orders with a specific clinical indication, such as paroxysmal atrial fibrillation, syncope, or palpitations
2. Patient consent documentation
3. Daily surveillance logs from the attended monitoring center
4. Final interpretation report completed within the 30-day monitoring period
5. Verification that no prior telemetry occurred within the preceding 3 months

Medical Necessity Requirements for 93229

CPT 93229 requires specific ICD-10 diagnosis codes supporting medical necessity, such as atrial fibrillation, syncope (R55), palpitations (R00.2), or cerebral infarction (I63.9). Documentation must show physician history, physical examination findings, and evidence that conservative approaches have been tried. MCOT is considered medically necessary for suspected arrhythmias when Holter monitoring has failed or symptoms occur less frequently than every 48 hours.

High-Risk Denial Triggers to Watch

Claims are commonly denied due to a mismatch between diagnosis (ICD-10) and procedure (CPT) codes, missing modifiers, or incomplete paperwork. Improper billing occurs when ordering Holter and MCOT simultaneously, as this is not considered medically necessary. Missed 93229 billing can cause a $200 to $400 loss per patient episode, and practices may lose $50,000 to $100,000 each year from recurring compliance gaps.

How Rhythm360 Automates Telemetry CPT Compliance

Rhythm360 solves core compliance problems for cardiology practices by automating remote patient monitoring documentation and billing for CIED and chronic care programs. The vendor-neutral platform ingests data from Medtronic, Abbott, Boston Scientific, Biotronik, and other manufacturers, which removes the need to manage multiple OEM portals. The platform’s AI-powered data reliability engine reaches more than 99.9% transmissibility through redundant data feeds and computer vision that processes APIs, HL7, XML, and unstructured PDFs.

Automated reporting tools generate compliant documentation for CPT billing and track billable events in real time. Intelligent alerting shortens response times for critical events by up to 80% through AI triage that filters non-actionable notifications. Bi-directional EHR integration with Epic, Cerner, and other major systems supports a single, consistent workflow. Case studies show practices recovering lost revenue and reaching up to 300% profit increases through stronger CPT capture and lower administrative overhead.

Schedule a demo to see how Rhythm360 automates remote patient monitoring, CPT compliance, and increases practice revenue.

Rhythm360 Implementation Roadmap and Vendor Comparison

Successful rollout of automated RPM compliance follows a clear plan that covers integration, workflows, and staff training. Most onboarding timelines range from a few days to a few weeks and include EHR integration, device manufacturer API connections, and team training on the unified dashboard.

The maturity path moves from manual portal management and reactive billing to AI-driven compliance monitoring with proactive revenue capture. SaaS pricing scales with practice size and usage, which supports flexible investment that matches growth.

Strategic Telemetry Billing Pitfalls to Avoid in 2026

Heavy reliance on individual OEM portals creates data silos that hide billable events and widen compliance gaps. Alert fatigue from legacy systems overwhelms staff and slows responses to urgent patient events. Ignoring Local Coverage Determinations from Medicare Administrative Contractors like Noridian and JF Part B increases audit risk and claim denials. Practices without bi-directional EHR integrations face manual documentation work that harms efficiency and accuracy. Lack of automated CPT tracking causes major revenue leakage, with some practices losing 20% to 40% of eligible reimbursements from missed billing and weak documentation.

FAQs: Cardiac Telemetry Monitoring CPT Compliance

What is the CPT code for cardiac telemetry monitoring?

Cardiac telemetry monitoring uses two primary CPT codes. Code 93228 covers the professional component, which includes physician review and interpretation. Code 93229 covers the technical component, which includes device support, surveillance, and data transmission. Both codes describe external mobile cardiovascular telemetry with real-time data analysis and transmission to an attended surveillance center for up to 30 days. Each code can be billed only once per 30-day monitoring period.

How do Holter monitor CPT codes differ from telemetry codes?

Holter monitoring uses CPT codes 93224 through 93227 for continuous ECG recording that lasts 24 to 48 hours and does not include real-time transmission. Cardiac telemetry monitoring with codes 93228 and 93229 provides continuous real-time monitoring with attended surveillance for up to 30 days. Telemetry works better for patients with infrequent symptoms that occur less often than every 48 hours. The main differences involve real-time transmission and longer monitoring duration.

What are the CMS guidelines for cardiac telemetry billing compliance?

CMS guidelines require physician orders, patient consent, daily surveillance logs, and final interpretation reports. Medical necessity must be supported by ICD-10 diagnosis codes such as paroxysmal atrial fibrillation, syncope, or palpitations. The monitoring period cannot exceed 30 days per episode, and no extra claims are separately reportable within that same episode. Providers also must confirm that no prior telemetry occurred within the previous 3 months.

What FDA requirements apply to cardiac telemetry devices?

Cardiac telemetry systems used for remote monitoring fall under Class III high-risk devices and require FDA Premarket Approval with scientific evidence and clinical trial data. Devices must automatically record and digitally transmit physiological data to qualify as medical devices under FDA oversight. ECG patches and similar wearables used for diagnosis or monitoring require FDA clearance or approval based on risk level.

Why do CPT 93229 claims get denied?

Common denial reasons include mismatched ICD-10 and CPT codes, missing modifiers, incomplete medical necessity documentation, and billing both Holter and MCOT at the same time. Claims also fail when diagnosis codes that support medical necessity are missing, when physician history and examination findings are absent, or when monitoring exceeds the once-per-30-days limit. Strong documentation and alignment with Local Coverage Determinations support higher approval rates.

Schedule a demo to see how Rhythm360 reduces billing errors and automates remote patient monitoring compliance.

Conclusion: Protect 2026 Telemetry Revenue with Rhythm360

The 2026 regulatory environment requires automated tools that manage CPT 93228 and 93229 compliance and protect cardiac telemetry revenue. Rhythm360’s vendor-neutral platform removes manual documentation work, reduces claim denials, and captures missed billable events through intelligent automation. Practices that adopt comprehensive RPM solutions report higher compliance, better staff efficiency, stronger patient outcomes, and significant revenue growth.

Schedule a demo today to see how Rhythm360 can transform your cardiac telemetry monitoring program and unlock up to 300% revenue gains for your practice.