Cardiac stress testing is a cornerstone in diagnosing ischemic heart disease, evaluating exercise tolerance, and assessing cardiovascular risk. However, because the test can involve multiple providers and entities, stress-test billing is often split into three separate CPT codes:
- 93016 – Supervision only
- 93017 – Tracing only
- 93018 – Interpretation only
This article provides a full, evergreen guide to CPT 93016 — including when to use it, Medicare supervision rules, documentation requirements, prior authorization needs, payer restrictions, and common denial reasons. Avoid stress-test denials and understand payer variations with our
CPT 93015 Cardiac Stress Test Billing Guide covering supervision, NCCI edits, and interpretation rules.
What Is CPT 93016?
Official CPT Definition:
“Cardiovascular stress test… supervision only, without interpretation and report.”
In simple terms:
CPT 93016 = The physician supervising the test (nothing else).
Use this code only when you supervise the stress test but do NOT perform the tracing or the interpretation.
Understanding the Stress Test Billing Structure
Stress tests are billed using three separate CPT codes when different parties perform different components.
| CPT Code | Component | Who Bills It? |
| 93016 | Supervision only | Physician supervising the test |
| 93017 | Tracing only | Facility or equipment owner |
| 93018 | Interpretation only | Physician reading the test |
If your practice performs all three, you would instead bill 93015 (the global code).
But when services are split (hospital, imaging center, or supervising cardiologist model), 93016 is used.
Reduce audit risk by reviewing our practical CPT 93308 Limited Echocardiogram Billing Guide
designed for real-world cardiology documentation needs.
When to Bill CPT 93016
You should bill CPT 93016 when:
✔ You supervise the stress test
You are actively overseeing the test to ensure safety and clinical appropriateness.
✔ Another entity performs the technical portion
Such as:
- Hospital tech
- Outpatient diagnostic center
- Separate cardiology facility
✔ You do not interpret the test
The interpreting cardiologist will bill 93018 separately.
✔ You do not own the equipment
Ownership determines who bills 93017 (technical component).
✔ The test is done under direct supervision
This is extremely important for Medicare.
Medicare Supervision Requirements for CPT 93016
Medicare requires direct supervision for stress tests. Ensure clean claims for non-Doppler echo studies using our CPT 93307 Transthoracic Echocardiogram Billing Guide fully updated for 2024–2025.
Direct supervision means:
- The supervising physician must be physically present in the office suite
- Must be immediately available
- Does not have to be in the same room
- Tele-supervision is NOT allowed for stress testing
Who is allowed to supervise?
Under Medicare:
- MD/DO only
- NPs/PAs cannot supervise stress tests for Medicare patients
- Some commercial payers allow NP/PA supervision (depending on policy)
If a non-physician supervises a Medicare stress test:
❌ CPT 93016 is not billable → reimbursement denied.
What CPT 93016 Includes (and Does NOT Include)
CPT 93016 includes:
- Medical supervision during the stress test
- Immediate availability for intervention
- Oversight of patient safety
- Decision-making regarding test continuation/termination
CPT 93016 does NOT include:
- ECG tracing (93017)
- Interpretation (93018)
- Final report
- Technical component
- Equipment ownership
This is why documentation must clearly show the supervising physician’s involvement.
Documentation Requirements for CPT 93016
Payers often deny 93016 due to incomplete supervision documentation. To avoid denials, your chart must include:
1. Statement of supervision
Example:
“Stress test performed under the direct supervision of Dr. ____.”
This line alone prevents many denials. Strengthen documentation and avoid denials with our expert
CPT 93306 Complete Echocardiogram Billing Guide written specifically for cardiology practices.
2. Supervision start/stop times
Not required by all payers, but recommended.
3. Stress modality used
- Exercise (Bruce, Modified Bruce, Naughton)
- Pharmacologic (Lexiscan, Dobutamine, Adenosine)
4. Reason for performing the test
Document medical necessity, such as:
- Chest pain
- Dyspnea on exertion
- Abnormal ECG
- Pre-operative exam
- Palpitations
5. Safety oversight
If symptoms develop:
- Chest discomfort
- Arrhythmias
- Hypotension
- Hypertensive response
- Dizziness or syncope
Document what you observed or instructed.
6. Test termination reason
Examples:
- Target HR achieved
- Fatigue
- Abnormal findings
- Patient request
7. Physician signature
Unsigned = automatic denial.
Prior Authorization Requirements for CPT 93016
Because 93016 is part of the stress test bundle, authorization depends on the payer and the test itself — not just the supervision code.
Medicare
- No prior authorization
- Must meet medical necessity criteria
Medicaid
Varies by state; some require PA for:
- Pharmacologic stress
- Repeat studies
- High-risk patients
Commercial Plans
Most major payers require authorization for all cardiac stress testing:
| Payer | Prior Auth for Stress Test? |
| Aetna | Often yes |
| UnitedHealthcare | Yes |
| Cigna | Yes |
| Anthem/BCBS | Commonly yes |
| Humana | Yes |
| Ambetter | Yes |
If the stress test requires authorization:
→ 93016 also requires authorization
→ 93017 also requires authorization
→ 93018 also requires authorization
Authorization is typically based on:
- Symptom severity
- ECG changes
- Cardiac risk factors
- Previous imaging
- Why is the test medically necessary now
If the PA is missing, all three codes (93016, 93017, 93018) are denied.
Common Denials for CPT 93016
And how to avoid them.
❌ 1. Missing “direct supervision” documentation
Add a simple line:
“Directly supervised by Dr. ____.”
❌ 2. NP/PA supervised a Medicare stress test
Medicare requires physician supervision.
❌ 3. Incorrect split-billing
Example:
Billing 93016 + 93018 when another provider interpreted the test.
❌ 4. No medical necessity
Documentation must support:
- Symptoms
- Risk factors
- Abnormal findings
❌ 5. No prior authorization
Most commercial plans will deny the entire stress test bundle without PA.
❌ 6. Patient not in the same suite as the supervising doctor
Supervision must be physical, not virtual.
❌ 7. Duplicate billing
Multiple supervising physicians billing 93016 for the same test results in denial.
Correct Billing Scenarios
Scenario 1 — Hospital Provides Technical Component
Hospital tech performs ECG + treadmill test
Cardiologist supervises
Cardiologist interprets
Billing:
- Hospital → 93017
- Cardiologist → 93016 + 93018
Scenario 2 — Cardiologist Supervises but Another Physician Interprets
Supervising physician → 93016
Interpreting physician → 93018
Facility → 93017
Scenario 3 — Physician Supervises Only (No Interpretation)
Use 93016 only.
Final Thoughts
CPT 93016 is one of the most commonly misunderstood stress-test billing codes. Because the code covers only supervision, accurate split billing, correct documentation of direct supervision, and proper prior authorization handling are essential for clean claims and full reimbursement. Improve reimbursements instantly by using our detailed CPT 93000–93010 EKG Billing Guide to code EKG services correctly the first time.
Cardiology practices performing stress tests in partnership with hospitals or diagnostic centers often lose revenue due to incorrect coding of the supervision component. Ensuring that notes clearly reflect direct supervision is the key to preventing denials.
If your clinic needs help with correct cardiology coding, split-billing workflows, or payer-specific stress-test authorization requirements, Global Tech Billing LLC supports cardiology practices with accurate coding and denial prevention systems.
Frequently Asked Questions (FAQ)
1. Can NPs or PAs bill 93016?
- Medicare: No
- Some commercial plans: Yes (must verify)
2. Does CPT 93016 include interpretation?
No — interpretation must be billed separately as 93018.
3. Can multiple doctors bill 93016 for the same test?
No. Only one supervising provider may bill.
4. Does CPT 93016 require prior authorization?
Only if the stress test itself requires authorization.
5. Can 93016 be billed with an E/M visit?
Yes — if the E/M is separately identifiable.
You must add modifier 25.
6. Does the supervising physician need to stay in the room?
No, but must be in the same office suite and immediately available.
7. Is tele-supervision acceptable?
No in-person supervision is required.
