Mobile Cardiac Telemetry (MCT) has become one of the most widely used cardiac monitoring solutions for detecting intermittent arrhythmias, especially those that do not appear on standard ECGs or 24-hour Holter monitors. With real-time transmission, automated arrhythmia detection, and continuous rhythm analysis, MCT is considered one of the most advanced forms of external cardiac monitoring.
For billing purposes, MCT uses two primary CPT codes:
- 93228 — Technical services + physician review and interpretation
- 93229 — Analysis only (used by IDTFs or device companies)
This guide focuses on CPT 93228, the code most commonly billed by cardiology clinics, medical practices, and providers who perform MCT monitoring in-office.
Below is a comprehensive, accurate, and evergreen guide to CPT 93228, including when to use it, documentation requirements, payer rules, whether prior authorization is needed, and common denial reasons. Improve accuracy for 24-hour cardiac monitoring with our CPT 93224 Holter Monitor Billing Guide including documentation, hooks, interpretation rules, and NCCI edits.
What Is CPT 93228?
Official CPT definition:
“External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real-time data analysis, and greater than 24 hours up to 30 days of continuous rhythm monitoring; review and interpretation by a physician or other qualified health care professional.”
In simple terms:
CPT 93228 = Physician review + interpretation of mobile cardiac telemetry monitoring.
This code is typically used when:
- The MCT device company handles the technical components
- Your clinic/provider reviews the results
- You produce a final interpretation + report
- Monitoring duration is more than 24 hours and up to 30 days
If your clinic does NOT do the technical component, you bill 93228 alone, and the MCT company uses 93229. Avoid common ECG billing errors by reviewing our comprehensive CPT 93000 12-Lead ECG Billing Guide built to support cardiology practices seeking cleaner claims.
What CPT 93228 Includes
To bill 93228 correctly, the following must occur:
1. Data transmission & monitoring
- Heart rhythm data is transmitted continuously
- Automated detection analyzes arrhythmias
- A device company typically performs real-time monitoring
2. Final data compilation
You receive:
- Summary report
- Arrhythmia events
- Heart rate trends
- Burden percentages (e.g., PVC burden, AF burden)
- Strips with annotations
3. Physician review
The interpreting provider must review:
- All significant events
- Symptoms logged by the patient
- Arrhythmias detected
- Rhythm strips
- Correlation with diary entries
4. Final diagnostic report
A complete report must include:
- Findings
- Interpretation
- Impression
- Recommendations
- Signature + credentials
When to Use CPT 93228
You may bill 93228 when:
- MCT monitoring is performed for >24 hours and up to 30 days
- Your clinic or provider reviews the MCT results
- You generate a final interpretation report
- The technical portion is performed by the device vendor or IDTF
Typical indications include:
- Palpitations
- Syncope
- Near-syncope
- Intermittent arrhythmias
- Paroxysmal atrial fibrillation
- Tachycardia/bradycardia episodes
- Post-ablation monitoring
- Post-stroke evaluation for occult AF
- Unexplained dizziness
- PVC/PAC burden assessment
- Monitoring after starting antiarrhythmic therapy
- Cryptogenic stroke evaluation
This makes MCT especially useful when Holter or event monitors have not provided answers.
Ensure cleaner claims for non-Doppler echo studies with our CPT 93307 Echocardiogram Without Doppler Billing Guide updated for 2024–2025 coding and payer requirements.
When NOT to Use CPT 93228
CPT 93228 should NOT be billed when:
❌ Monitoring is less than 24 hours
Use ECG or Holter codes.
❌ Monitoring is 24–48 hours
Use Holter code 93224 (global) or component codes.
❌ Monitoring is >48 hours but NOT real-time telemetry
Use extended patch monitoring codes (93241–93244).
❌ Your clinic did NOT interpret the results
Then only the device vendor uses 93229.
❌ Results are incomplete, or no final report was created
A signed interpretation is required.
❌ The service was performed in an inpatient setting
Use telemetry or inpatient ECG codes.
Understanding 93228 vs 93229
If you only interpret the MCT, you bill 93228.
If a device company performs the service:
| Code | Who Bills It | What It Covers |
| 93228 | Physician/clinic | Review + interpretation |
| 93229 | Device company/IDTF | Technical + analysis |
Together, they represent the full MCT service.
Documentation Requirements for CPT 93228
Payers require complete documentation to avoid denials. Your notes must include:
1. Medical necessity
Examples:
- “Patient reports intermittent palpitations occurring weekly.”
- “Syncope with unknown cause.”
- “Post-ablation monitoring for recurrence of AF.”
- “Cryptogenic stroke—evaluating for paroxysmal AF.”
2. Monitoring period
Include:
- Start date
- End date
- Total monitoring duration
3. Summary of significant findings
Examples:
- AF burden percentage
- Number of PVCs
- Longest pause
- Max/min heart rate
- Runs of VT or SVT
- Bradyarrhythmias
4. Provider interpretation
Interpretation must address:
- Rhythm
- Arrhythmias
- Ectopy
- Conduction patterns
- Event-symptom correlation
- Clinical significance
5. Final signed report
Required by Medicare and commercial payers. Strengthen compliance for TTE procedures using our detailed CPT 93306 Transthoracic Echocardiogram Billing Guide featuring documentation tips, supervision rules, and NCCI guidance.
Prior Authorization Requirements for CPT 93228
Most MCT studies do require prior authorization, especially under commercial plans.
Medicare
- Generally does NOT require prior authorization
- Must meet medical necessity
Medicaid
- Varies by state
- Many require PA due to the cost of MCT
Commercial Insurance (most common scenario)
These commonly require PA:
- BCBS (many states)
- Aetna
- UHC
- Cigna
- Ambetter
- Oscar
- HealthNet
- Anthem HMO
- Kaiser
Because MCT is more expensive than a Holter, most HMO plans require clinical justification and PA.
Best practice
ALWAYS verify prior authorization for MCT.
Common Denials for CPT 93228 (And How to Avoid Them)
❌ 1. Missing medical necessity
Always include symptoms and justification.
❌ 2. No signed interpretation
Unsigned reports = automatic denial.
❌ 3. Wrong code (monitor was not telemetry)
If not real-time → use patch monitoring codes.
❌ 4. Missing start/stop dates
Dates are essential.
❌ 5. Billed when only technical services were performed
If you did not interpret → do NOT bill 93228.
❌ 6. Overlapping monitoring services
Cannot bill two monitors for the same period.
❌ 7. Prior authorization missing
Most commercial plans deny without PA.
Billing Scenarios for CPT 93228
Scenario 1 — Device Company Handles Technical Services
The device vendor performs the technical component
They bill 93229
Your clinic interprets results → 93228
Scenario 2 — Clinic Provides MCT Device and Interpretation
If your practice handles BOTH technical and interpretive services, you may still bill 93228 only if the device company does not bill 93229.
Rare scenario, but possible.
Scenario 3 — Only a Holter Was Performed
Holter ≠ MCT.
Use 93224 instead.
ICD-10 Codes Commonly Paired With CPT 93228
- R00.2 – Palpitations
- R55 – Syncope
- R42 – Dizziness
- I48.91 – Atrial fibrillation
- I47.1 – SVT
- I47.2 – VT
- I49.3 – PVCs
- I49.1 – PACs
- I49.5 – Sick sinus syndrome
- G45.9 – TIA
- I63.9 – Ischemic stroke (cryptogenic)
- Z86.73 – Personal history of TIA/stroke
Final Thoughts
CPT 93228 is one of the most important cardiac monitoring codes used for detecting intermittent and hard-to-capture arrhythmias. Because it involves interpretation of large datasets and real-time telemetry analysis, accurate documentation and proper coding are essential. Improve accuracy and reduce payer denials with our expert CPT 93018 Stress Test Interpretation Billing Guide covering documentation, medical necessity, and interpretation rules.
Understanding medical necessity, payer-specific rules, prior authorization requirements, and the correct use of companion code 93229 are key to clean and compliant billing.
If your cardiology or primary care clinic needs support with MCT billing workflows, prior authorizations, or denial reduction, Global Tech Billing LLC provides expert assistance tailored to cardiac monitoring services.
Frequently Asked Questions (FAQ)
1. What is the difference between MCT and an event monitor?
MCT is real-time, continuous monitoring with automated arrhythmia detection.
Event monitors require patient activation.
2. Can MCT be billed for less than 24 hours?
No. Must be >24 hours.
3. Can multiple MCT devices be billed in a single month?
Yes, but you must document new symptoms or clinical necessity.
4. Is CPT 93228 billable via telehealth?
Interpretation may take place via telehealth, but the monitoring is in-person.
5. Can NPs or PAs bill 93228?
Yes, if allowed by the payer and state scope laws.
6. Does MCT require patient consent?
Most payers expect documented patient education and consent.
