Holter monitoring is a core diagnostic tool in cardiology for evaluating arrhythmias, palpitations, dizziness, unexplained syncope, and intermittent cardiac symptoms that may not appear during a standard 12-lead ECG. The 24-hour Holter monitor remains the most widely performed cardiac ambulatory study in outpatient cardiology, primary care, and diagnostic centers.
CPT 93224 is the global code used when your clinic performs all three components of the 24-hour Holter study:
- Recording
- Scanning/analysis
- Interpretation and report
Because Holter billing varies by payer, documentation quality, and whether services are split between facilities and physicians, the correct use of CPT 93224 is essential for clean claims.
This comprehensive guide explains exactly when to use CPT 93224, what it includes, when NOT to use it, payer rules, prior authorization requirements, and common denials.
What Is CPT 93224?
Official CPT definition:
“External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; including recording, scanning analysis with report, and review and interpretation by a physician or other qualified health care professional.”
In simple terms:
CPT 93224 = the ENTIRE Holter service (recording + analysis + interpretation).
Use this code only when your practice completes all parts of the test.
If the components are split (e.g., one clinic records, another interprets), then you must use the component codes (93225–93227).
What CPT 93224 Includes
To bill 93224 correctly, your practice must provide:
1. Holter monitor placement & recording (up to 48 hours)
- Applying electrodes
- Connecting leads
- Starting the monitor
- Instructing the patient
- Ensuring proper functioning
- Documenting start/stop times
2. Scanning & analysis
- Uploading data
- Reviewing continuous rhythm strips
- Identifying arrhythmias
- Detecting ST abnormalities
- Analyzing heart rate trends
- Marking significant events
3. Interpretation & final report
A physician or qualified provider must review:
- Arrhythmias detected
- Ectopy
- Pauses
- Atrial arrhythmias
- Ventricular arrhythmias
- Conduction abnormalities
- Heart rate variability
- Symptom-rhythm correlation
Report must include:
- Findings
- Diagnostic impression
- Any recommendations
- Signature
When to Use CPT 93224
Bill CPT 93224 when:
✔ Your facility applies the Holter monitor
✔ The patient wears it for up to 48 hours
✔ Your practice performs the scanning/analysis
✔ A clinician in your practice interprets the results
✔ You produce a complete, signed report
Common clinical indications:
- Palpitations
- Syncope
- Lightheadedness
- Dizziness
- Suspected arrhythmia
- Afib evaluation
- PVC/PAC burden assessment
- Bradycardia or tachycardia evaluation
- Near-syncope
- Post-ablation monitoring
- Post-MI arrhythmia screening
- Antiarrhythmic drug monitoring
When NOT to Use CPT 93224
Do not bill 93224 if:
❌ You only applied the Holter
Use 93225
❌ You only performed scanning/analysis
Use 93226
❌ You only interpreted the Holter report
Use 93227
❌ Monitoring exceeds 48 hours
Use codes for patch, extended, or event monitoring (e.g., 93241–93248)
❌ The patient was monitored internally (inpatient telemetry)
Use inpatient telemetry codes (not Holter codes)
❌ The study failed/was aborted
You may need modifier or component billing depending on circumstances.
CPT 93224 vs 93225–93227 (Component Codes)
If your practice does all 3:
CodeUse When
93224 Recording + analysis + interpretation
If split:
CodeComponent
93225 Recording only
93226 Scanning/analysis only
93227 Interpretation & report
Documentation Requirements for CPT 93224
To avoid denials, ensure your notes include:
✔ 1. Medical necessity
ICD-10 examples:
- R00.2 – Palpitations
- R42 – Dizziness
- R55 – Syncope
- I49.3 – PVCs
- I49.1 – Atrial premature beats
- I47.1 – Supraventricular tachycardia
- I48.91 – Atrial fibrillation
- I45.1 – AV block
✔ 2. Device placement
Document:
- Date/time placed
- Patient instructions given
- Any troubleshooting
✔ 3. Monitoring period
Include:
- Start date/time
- Stop date/time
✔ 4. Analysis summary
Examples:
- “Total beats: ___”
- “PVC burden: ___%”
- “Longest pause: ___ seconds”
- “Max HR: ___, Min HR: ___”
✔ 5. Interpretation
A physician/qualified provider must include:
- Rhythm findings
- Arrhythmias
- Ectopy
- ST events
- Correlation with symptoms
✔ 6. Final impression & signature
Required for reimbursement.
Prior Authorization Requirements for CPT 93224
Holter monitors usually do NOT require prior authorization, but there are exceptions.
Medicare
- No prior authorization
Medicaid
Varies by state (most do not require PA).
Commercial Payors
Most do NOT require PA unless:
- Patient has a restrictive HMO
- Monitoring is repeated frequently
- Plan uses cardiology imaging programs (e.g., AIM, Evicore)
Plans MOST likely to require PA:
- Kaiser
- Ambetter
- HealthNet
- Some BCBS HMO plans
Good rule:
If in doubt → verify PA.
Reimbursement Rate for CPT 93224
Average national Medicare reimbursement (approximate):
⭐ $50–$90 depending on region.
Commercial payers often pay higher.
Common Denials for CPT 93224 (And How to Fix Them)
❌ 1. Wrong code billed (should have used 93225–93227)
If your clinic didn’t do ALL steps, don’t bill 93224.
❌ 2. Missing analysis documentation
Simply attaching a PDF from the device is NOT sufficient.
Document that the staff reviewed the tracing.
❌ 3. Missing interpretation/signature
A physician must interpret and sign.
❌ 4. Insufficient medical necessity
Avoid vague terms like “routine check.”
❌ 5. Incorrect dates (start/stop mismatch)
Always include the exact wear period.
❌ 6. Monitoring >48 hours
Use 93241–93248 for extended monitoring.
❌ 7. Missing patient consent or instructions
Some payers require proof that Holter instructions were given.
Correct Billing Scenarios
Scenario 1 — Cardiology Practice Performs Entire Holter Test
Clinic places monitor
Patient returns
Clinic uploads data and performs scanning
Physician interprets and reports
→ Bill 93224
Scenario 2 — Primary Care Office Uses a Holter Device
Office places monitor
The device company sends data
Clinic scans and interprets
→ Bill 93224
(as long as the staff analyzed AND the provider interpreted)
Scenario 3 — Outside Facility Records, You Interpret Only
Facility → 93225 + 93226
Your office → 93227
Final Thoughts
CPT 93224 is one of the most commonly billed cardiac monitoring codes—and one of the easiest to misuse. Proper component billing, complete documentation, clear interpretation, and accurate ICD-10 coding are essential for avoiding denials.
If your practice needs help improving Holter monitor billing, scanning workflow, or payer-specific documentation, Global Tech Billing LLC provides cardiology-focused billing expertise to help you get paid accurately and consistently.
Frequently Asked Questions (FAQ)
1. Can NPs/PAs interpret Holter monitors?
Depends on payer rules.
Medicare allows “qualified healthcare professionals.”
2. Is CPT 93224 billable on the same day as an E/M visit?
Yes — if medically necessary and documented separately.
3. Can a Holter be billed twice in one month?
Yes, if clinically necessary.
Document the reason (e.g., new symptoms).
4. Do digital Holter devices count?
Yes — as long as they provide continuous ECG signals.
5. Does CPT 93224 cover patch monitors?
No. Patch/extended monitors use 93241–93248.
6. Do payers allow a 48-hour Holter?
93224 covers up to 48 hours.
7. Does CPT 93224 require image storage?
Yes — ECG tracings must be stored
