Cardiac stress testing is one of the most common diagnostic tools for evaluating chest pain, shortness of breath, exercise intolerance, arrhythmias, and coronary artery disease. Because stress testing often involves participation from multiple parties — such as the facility performing the test and the clinicians supervising or interpreting it — each participant bills only for the portion of the service they provide.
CPT 93017 is used when your facility performs the actual stress test procedure, including ECG acquisition and physiologic monitoring, but another provider handles supervision and/or interpretation.
This guide explains exactly when CPT 93017 is appropriate, what documentation is required, how prior authorization works, Medicare rules, common denial reasons, and how to ensure clean claims.
What Is CPT 93017?
According to CPT:
“Cardiovascular stress test… tracing only.”
In practical clinical terms, CPT 93017 represents:
All of the work your facility does to physically perform and administer the stress test, such as:
- Setting up the patient
- Applying ECG leads
- Capturing baseline ECG
- Running on a treadmill or bicycle exercise
- Administering pharmacologic stress when required
- Recording ECG data continuously
- Monitoring blood pressure and symptoms
- Documenting physiologic responses
- Recording post-test recovery data
If your clinic or facility performs the stress test itself, you bill 93017.
A different provider will bill separately for:
- Supervision (CPT 93016)
- Interpretation (CPT 93018)
When Should You Bill CPT 93017?
You should bill 93017 when your staff performs the test, meaning:
✔ You conduct the full exercise or pharmacologic portion of the test
This includes tests using:
- Treadmill
- Bicycle ergometer
- Lexiscan
- Dobutamine
- Adenosine
✔ Your staff performs ECG application and continuous monitoring
Electrode placement and ECG recording are part of 93017.
✔ Your facility manages patient safety during the test
This includes monitoring:
- Heart rate
- Blood pressure
- Symptoms
- ST-segment changes (observed by staff)
✔ You document all required physiologic data
No interpretation — just accurate recording.
✔ The supervising provider and interpreting provider are separate
Your facility performs the test while a physician supervises and/or interprets.
✔ Your facility owns or provides the equipment used for the stress test
This includes:
- ECG machine
- Treadmill/bike
- Stress agents (for pharmacologic studies)
If your office handles the entire “hands-on” portion of the test, CPT 93017 is the correct code.
What CPT 93017 Includes
CPT 93017 covers all activities directly involved in carrying out the stress test, such as:
1. Patient Preparation
- Obtaining the history needed for safety
- Explaining the test
- Placing ECG electrodes
- Obtaining a resting ECG
2. Conducting the Stress Portion
- Starting the treadmill protocol
- Monitoring physiologic response
- Administering pharmacologic agents when indicated
- Documenting each stage
3. Recording Data
- Continuous ECG recording
- Blood pressure readings
- Symptom reports
- Exercise capacity
- Recovery phase documentation
4. Clinical Support During the Test
- Observing for arrhythmias
- Watching for ischemic symptoms
- Stopping the test if unsafe
- Safety precautions
CPT 93017 DOES NOT include:
- Supervising the test
- Making clinical decisions
- Interpreting ECG results
- Creating a diagnostic report
Documentation Requirements for CPT 93017
To submit CPT 93017 successfully, your documentation must clearly show that your facility performed the stress test.
Required elements include:
✔ Reason for the Test (Medical Necessity)
Examples:
- Chest pain
- Shortness of breath
- Palpitations
- Abnormal ECG
- CAD evaluation
- Pre-operative cardiac assessment
✔ Resting ECG Findings
Before stress begins.
✔ Stress Method Used
Examples:
- Bruce protocol
- Modified Bruce
- Naughton
- Dobutamine
- Lexiscan
✔ Monitoring Details
Document:
- Blood pressure at each stage
- Heart rate progression
- Symptoms
- ST changes (description, not interpretation)
- Rhythm abnormalities observed
✔ Timing and Stage Documentation
Such as:
- Stage 1, Stage 2, Stage 3
- Exact METs and duration
- Recovery period timing
✔ Any Adverse Events
Examples:
- Hypertensive response
- Hypotension
- Arrhythmias
- Chest discomfort
- Dizziness
✔ Test Completion or Early Termination Reason
Examples:
- Achieved target heart rate
- Fatigue
- Symptoms
- Safety concerns
✔ Signatures of the staff who performed the test
(Physician signature belongs in the 93018 documentation.)
Prior Authorization Requirements for CPT 93017
Authorization for stress tests depends heavily on payer guidelines.
Since 93017 is part of the overall stress test, authorization generally applies to the entire test, meaning:
👉 If the stress test requires prior authorization, 93017 also requires authorization.
Here’s how different payers handle it:
Medicare
- Does NOT require prior authorization for stress tests
- Requires medical necessity
- Supervising physician must meet Medicare rules (affects 93016)
Medicaid
State-specific.
Some states require authorization for:
- Pharmacologic stress
- Repeat stress tests
- High-risk patients
Others only require documentation of necessity.
Commercial Insurance (Most Require Authorization)
Major payers often require authorization for all forms of cardiac stress testing:
| Payer | Authorization Required? |
| Aetna | Yes (typically) |
| Cigna | Yes |
| UHC | Yes |
| Anthem/BCBS | Often yes |
| Humana | Yes |
| Ambetter | Yes |
If authorization is missing, all components billed by all parties are usually denied (93016, 93017, 93018).
Common Denials for CPT 93017
Here’s what most payers deny — and how to avoid it:
❌ 1. No prior authorization
If authorization is required and missing, 93017 will be denied, even if supervision and interpretation were authorized.
Fix: Check PA rules for every plan.
❌ 2. Missing documentation of the stress portion
If the test stages, timing, or monitoring aren’t documented, payers assume the test wasn’t carried out.
❌ 3. Incorrect ICD-10
Symptoms must support medical necessity.
❌ 4. No record of ECG acquisition
Payers expect details of:
- Lead placement
- Baseline ECG
- Continuous tracing
❌ 5. Duplicate billing
Example:
Two facilities are submitting 93017 for the same encounter.
❌ 6. Wrong code submitted
Some practices incorrectly bill 93015 even though only the test was performed.
❌ 7. Interpretation notes incorrectly added to 93017 documentation
Your notes must show performance, not interpretation.
Correct Billing Examples
Example 1: Hospital Performs the Stress Test
Hospital staff perform the test
Cardiologist supervises
Cardiologist interprets
Billing:
- Hospital → 93017
- Supervising cardiologist → 93016
- Interpreting cardiologist → 93018
Example 2: Outpatient Cardiology Center Performs the Test
The center performs an ECG and runs a treadmill
A physician in the same practice supervises
Another cardiologist interprets
Billing:
- Center → 93017
- Physician → 93016 + 93018
Example 3: Clinic Performs the Test, but an External Cardiologist Reads It
Clinic → 93017
Outside physician → 93018
Final Thoughts
CPT 93017 represents the core activities involved in administering a cardiovascular stress test. Correct documentation, proper authorization, and understanding payer-specific rules are crucial to ensuring clean claims. Many facilities lose significant revenue due to misunderstanding these rules or using the wrong code.
If your practice needs help with accurate stress-test billing, payer rules, or denial reduction strategies, Global Tech Billing LLC provides cardiology-focused billing and compliance support.
Frequently Asked Questions (FAQ)
1. Does CPT 93017 include interpretation?
No — interpretation is billed with 93018.
2. Does 93017 require prior authorization?
Usually YES for commercial plans.
3. Do you need a physician present to bill 93017?
A supervising physician (billing 93016) must be present, but your facility can still bill 93017 for running the test.
4. Does 93017 include pharmacologic stress?
Yes — if your facility administers the medication.
5. Can NPs or PAs perform the stress test?
They can help perform it depending on state regulations, but supervision rules apply to 93016.
6. What if the patient cannot complete the test?
You can still bill 93017 if the test was initiated and medically necessary.
7. Can 93017 be billed in telehealth settings?
No — stress tests must be performed in person.
