Electrophysiology is one of the most complex areas of cardiology billing. EP procedures involve:
- Intracardiac electrophysiologic studies
- 3D mapping
- Ablation of arrhythmia foci
- Additional ablation lines
- Imaging guidance (e.g., ICE)
- Post-ablation testing
Because multiple services occur in a single session, EP coding uses comprehensive primary codes + limited add-on codes. Incorrect sequencing, missing documentation, and bundling violations are the most common sources of denials. Strengthen your revenue cycle with the most detailed Cardiology Billing and Coding Guide covering E&M, procedures, imaging, stress testing, NCCI edits, and more.
The core EP ablation codes include:
- 93653 – SVT ablation + full EP study
- 93654 – VT ablation + full EP study
- 93656 – AF ablation + full EP study
- 93655 – Add-on for additional distinct arrhythmias
- 93657 – Add-on for additional AF substrate modification
Supporting codes:
- 93613 – 3D mapping (limited situations)
- 93662 – Intracardiac echocardiography (ICE)
- 93621 – Left atrial/ventricular pacing & recording
- 93623 – Programmed stimulation
- 93622 – Left atrial mapping
Many of these are routinely bundled, so documentation must justify when add-on codes are separately billable.
2. Core EP Ablation Codes
93653 – Comprehensive SVT Ablation
Includes:
- Full EP study
- Mapping (basic, not 3D)
- Ablation for SVT or atrial flutter
Typical indications:
- AVNRT
- AVRT
- Atrial flutter
- Atrial tachycardia
Bundling rules:
- 93613 (3D mapping) allowed if performed and documented.
- 93662 (ICE) is not automatically included—billable if medically necessary.
- 93655 allowed for additional arrhythmias, not variations of the same arrhythmia.
93654 – Ventricular Tachycardia (VT) Ablation
Includes:
- Full EP study
- Basic mapping
- VT ablation
Allowed add-ons:
- 93613 (3D mapping) — frequently used and payable when documented.
- 93662 (ICE) — allowed when used beyond routine visualization.
- 93655 — only if treating another arrhythmia distinct from VT.
93656 – Atrial Fibrillation (AF) Ablation
Includes:
- Pulmonary vein isolation (PVI)
- Full EP study
- LA pacing/recording
- Basic mapping
Important: AF ablation has the strictest bundling rules.
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Add-ons allowed:
- 93657 – Additional AF substrate modification
- 93613 – 3D mapping (if documented)
- 93655 – For non-AF arrhythmias (e.g., atrial flutter) treated in the same session
What’s included (cannot be billed separately):
- 93621
- 93622
- 93623
- 93662 (ICE) if used solely for PVI guidance
3. Add-On Codes Explained
93655 – Additional Arrhythmia Ablation
Used when:
- A separate arrhythmia is induced/documented (e.g., treating SVT during AF ablation)
- NOT for:
- Additional lines in the same arrhythmia
- Variations of AF
- Additional PVI lesions
Documentation must show:
- Distinct arrhythmia identified
- Separate mapping
- Separate ablation beyond AF work
93657 – Additional AF Substrate Modification
For extra AF-related lesions after PVI.
Examples:
- Roof line
- Mitral isthmus line
- Complex fractionated atrial electrograms (CFAE)
Must document:
- Lesions performed
- Purpose of substrate modification
- Medical necessity
93613 – 3D Mapping
Frequently allowed when:
- CARTO/EnSite/Rhythmia 3D mapping was used
- Documentation must specify:
- Technology used
- Clinical reason (scar, complex arrhythmia)
- Findings
Omission of mapping narrative = denial.
93662 – Intracardiac Echocardiography (ICE)
Billable when used to:
- Guide transseptal puncture
- Identify anatomy
- Visualize catheter placement
- Assess complications
NOT billable when used only for:
- Routine imaging during AF ablation
- Documentation must state:
“ICE used for transseptal guidance and real-time visualization of catheter deployment.”
4. Required Documentation Elements
To support EP coding, documentation must include:
Baseline Data
- Arrhythmia history
- Symptoms
- Failed medications
- Indications for ablation
EP Study Details
- Pacing protocols
- Inducibility
- Conduction intervals
- Mapping strategy
- Activation sequence
Ablation Details
- Arrhythmia targeted
- Energy type
- Duration
- Lesion locations
- Endpoints achieved (e.g., bidirectional block, PVI entrance/exit block). Improve accuracy and avoid payer denials with our comprehensive CPT 92960 Electrical Cardioversion Billing Guide covering documentation, clinical scenarios, and modifier rules.
Imaging & Mapping
- ICE guidance
- 3D mapping findings
Outcomes
- Arrhythmia termination
- Post-ablation inducibility testing
- Complications
- Missing these elements is the most common reason for CO16 “insufficient documentation.”
5. NCCI Bundling Rules (High-Risk Areas)
EP includes:
- Catheter placements
- Basic mapping
- LA pacing/recording
Therefore:
- Do NOT bill 93621, 93622, 93623 with 93653–93656
- Do NOT bill 93662 for routine AF ablation imaging
- Do NOT bill 93613 unless clearly documented
- Do NOT bill 93655 unless a distinct arrhythmia is treated
6. Common Payer Denials & How to Avoid Them
1. CO50 – Medical Necessity Not Met
Causes:
- No failed medication trial
- No arrhythmia documentation
- No symptom history
- Fix:
- Document arrhythmia burden
- Include ECG strips
- Include medication failures
2. CO97 – Bundling Edit / NCCI Conflict
Common issues:
- Billing 93621/93622 with AF ablation
- Billing 93655 for AF lines
- Fix:
- Ensure documentation supports a separate arrhythmia
3. CO16 – Insufficient Documentation
Causes:
- Missing mapping details
- No ablation lesion summary
- No inducibility testing
- Fix:
- Add mapping narrative
- Add procedural outcomes
4. CO197/198 – Prior Authorization Missing
EP ablations ALWAYS require PA for:
- AF
- VT
- SVT
- Atrial flutter
Ensure PA includes correct CPT codes:
- 93653
- 93654
- 93656
- 93655
- 93657
Incorrect CPT on PA = automatic denial.
7. Prior Authorization Requirements
PA submission must include:
- Arrhythmia type
- ECG evidence
- Holter/event monitor results
- Failed antiarrhythmic medication
- Symptoms & burden
- Prior ablation history
Missing ANY of these leads to PA denial.
8. ICD-10 Codes Commonly Accepted for EP Ablation
- I48.0–I48.91 – Atrial fibrillation/flutter
- I47.1 – SVT
- I47.2 – VT
- I49.5 – Sick sinus syndrome (in some VT cases)
Avoid using:
- Z-codes
- Non-specific palpitations for AF ablation
- Non-arrhythmic ICD-10s
9. Billing Checklist for EP Procedures
✔ Confirm correct primary code (93653/93654/93656)
✔ Add 93657 for additional AF lesions with documentation
✔ Add 93655 for distinct arrhythmias treated
✔ Add 93613 if 3D mapping documented
✔ Add 93662 if ICE guidance beyond “routine.”
✔ Do not bill bundled codes (93621/93622/93623)
✔ Use correct ICD-10
✔ Verify prior authorization matches the CPT billed
✔ Ensure full documentation of mapping, ablation, and outcomes. Protect your revenue by mastering denial patterns with our Cardiology Denials Playbook featuring high-risk codes, common payer triggers, and appeal strategies.
FAQ
1. What procedures are included in EP ablation codes 93653–93656?
Each code includes a full EP study, basic mapping, pacing, and initial ablation for the primary arrhythmia treated.
2. When can 93655 be billed?
93655 can be billed only when treating a separate, distinct arrhythmia (e.g., atrial flutter during AF ablation).
3. What is 93657 used for?
93657 is for additional AF substrate modification after pulmonary vein isolation (e.g., roof line, mitral line).
4. Is 3D mapping (93613) always billable?
No. It must be specifically documented with mapping details; otherwise, payers classify it as included.
5. When is ICE (93662) allowed?
ICE is payable when used for transseptal puncture guidance or real-time intracardiac visualization beyond routine AF imaging.
Reduce approval delays by reviewing our essential Cardiology Prior Authorization Guide with payer requirements, documentation templates, and workflow best practices.
6. Do EP ablations require prior authorization?
Yes. All EP ablations (SVT, VT, AF) require PA, and the PA must list the exact CPT codes (93653–93657).
7. What documentation is required for EP claims?
Arrhythmia type, inducibility, mapping strategy, lesion sets, ablation outcomes, and post-procedure testing.
8. What causes most EP claim denials?
Missing mapping details, incorrect bundling, invalid add-on code use, insufficient documentation, or PA issues.
