What this page covers
Cardiology billing services manage two revenue streams with different mechanics: a diagnostic side built on ECG, echocardiography, and stress-test volume, and an interventional side governed by global periods. Same-day evaluation and management visits need modifier 25 to pay alongside a 93306 echo or a 78452 nuclear study, NCCI edits bundle the tracings and Doppler codes, and advanced imaging authorization sits with eviCore or Carelon on many plans. Remote device monitoring adds recurring claims billed in fixed 30 and 90-day windows. Flexbone runs eligibility, authorization, modifier and window checks, and denial work for cardiology groups inside your EHR and billing system.
How does the diagnostic and interventional split shape cardiology billing?
Cardiology bills two different businesses under one tax ID. The diagnostic side runs volume: ECGs (93000, 93010), complete echocardiography with Doppler (93306), stress testing (93015 to 93018), and SPECT myocardial perfusion imaging (78452), often on the same day as an evaluation and management visit that must carry modifier 25 to pay separately. The interventional side runs global periods: pacemaker and defibrillator implants carry a 90-day global under the Medicare fee schedule, so follow-up visits bill only with modifier 24 for unrelated care, and staged or unplanned returns ride on modifiers 58 and 78. NCCI edits sit between the two: a stress test includes its ECG tracings, so a separate 93010 from the same session denies, and 93306 already includes the Doppler and color flow codes. The cardiovascular prior authorization page covers the procedure side.
Get an outside read on your cardiology billing workflow
In 30 minutes we map your current volume, the payers and systems involved, where staff time goes, and the highest-ROI calls and follow-ups Flexbone can take off your team first, scoped to the work you actually run.
How are remote monitoring and cardiac rehab billed?
Device follow-up is recurring revenue billed in fixed windows. Remote interrogation of pacemakers and defibrillators bills once per 90-day period (93294 and 93295 for the professional work, 93296 for the technical component), while implantable loop recorders and physiologic monitors bill once per 30 days (93297, 93298). Because each code pays once per period per patient, a submission whose window overlaps the previous claim denies, and a practice that does not track the calendar leaves completed interrogations unbilled. Cardiac rehabilitation bills per session with 93798 when continuous ECG monitoring is used, under payer session caps that need the same tracking. Flexbone reconciles the billing windows and session counts against the remittance record, and its denials management agents map the CARC codes on the 835 when a frequency or overlap edit comes back.
How does prior authorization work in cardiology billing?
On many commercial and Medicare Advantage plans, advanced cardiac imaging routes to a radiology benefit manager rather than the payer. Nuclear stress testing, coronary CT angiography (75574), cardiac MRI, and stress echocardiography commonly need approval through eviCore, Carelon, or HealthHelp, each with its own portal and clinical criteria, while device implants and interventional procedures carry documentation-heavy requests to the plan itself. The billing failure modes are concrete ones: no authorization on file when the study was performed, an approval whose CPT code no longer matches the study after a protocol change, or an approval issued to the wrong site or provider identifier. Flexbone checks the requirement when the order is placed, submits through the benefit manager the plan uses, and verifies the approved codes against the schedule. The cardiology prior authorization explainer covers the clinical criteria in depth.
How does Flexbone run cardiology billing?
Flexbone deploys browser and voice agents across the cardiology revenue cycle rather than staffing a coding desk. Agents verify eligibility before the visit, determine the authorization requirement for imaging, devices, and interventions, submit and track the requests, check modifier and global-period logic before claims file, and work the denial queue by CARC code inside your EHR and billing system. Remote monitoring and rehab claims are reconciled against their billing windows so the recurring revenue does not leak. The front-office side, diagnostic scheduling and the recall that keeps chronic patients on their monitoring cadence, is covered on the AI for cardiology page. Results write back with an audit trail, and exceptions route to your billers with the context attached.