Billing and coding for general cardiology offices, interventional and electrophysiology groups, non-invasive imaging labs and hospital-based cardiovascular practices.
A cardiology practice can document every study correctly and still lose the claim. Authorization for a nuclear study arrives after the scan. A remote device check lands inside a 90 day window that is already billed. A global charge goes out where the practice owns only the professional side of the work. Across 61,400 claims we audited, professional and technical component errors appeared on 7% of in-office diagnostic claims. None of that is a documentation problem.
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Cardiology billing services cover coding, claim submission, denial work and AR follow-up for cardiovascular practices, including catheterization, echocardiography, stress testing, nuclear imaging, electrophysiology and remote device monitoring. Luxen works inside the systems the practice already runs. Across 38 client practices, first-pass denial rate fell from 14.2% to 6.1% within 90 days of onboarding.
Cardiology billing changes with where the revenue comes from, and most practices run more than one of these lines at once.
We also bill the lines around the professional fee: cardiac rehabilitation, device clinic work, in-office drug administration, and the technical components you own.
The four patterns we see most often when auditing a cardiology practice before onboarding. Dollar figures are Luxen claim audit averages across 61,400 claims, not list charges.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Advanced imaging before authorization is confirmed | 78451 to 78454, 78429 to 78434 | Auth never obtained, expired, or for a different study | $612 average denied charge | Prior authorization was missing on 13% of advanced cardiac imaging claims |
| Remote device monitoring billed inside a closed interval | 93293 to 93296 | Second claim inside the same 90 day period, or an in-person check on top | $94 average denied charge | 9% of device interrogation and remote monitoring claims were denied for frequency |
| Office visit on the same day as a diagnostic test | 99213 to 99215 with 93000, 93306 | Modifier 25 left off, so the visit bundles into the test | $118 average charge lost | Modifier 25 was missing on 11% of same-day cardiology visit and test claims |
| In-office diagnostics with the wrong component | 93000, 93005, 93010, 93306, 93015 to 93018 | Global billed where only one component is owed | $71 median variance per claim | Professional and technical component errors appeared on 7% of in-office diagnostic claims |
The most common cardiology billing question we get. The answer is not about the specialty, it is about the global period on the other code on the claim.
Medicare assigns every procedure a global surgery indicator: 000 for a zero day post-operative period, 010 for 10 days, 090 for major surgery, XXX where the concept does not apply. It lives in the Physician Fee Schedule relative value file, per code, so it is looked up rather than assumed from the specialty or the procedure name.
The National Correct Coding Initiative Policy Manual, Chapter I, Section E, defines modifier 25 as a significant, separately identifiable evaluation and management service on the same day as a procedure. It applies to E/M reported with 000, 010 and XXX global procedures. The manual is explicit that work inherent to the procedure is not separately reportable, and that a separately identifiable E/M unrelated to the decision to perform it is.
In cardiology, the interpretation and brief discussion belonging to an echocardiogram are part of the echocardiogram. A visit that works up new dyspnea, adjusts heart failure medication and orders the study is separate, and the note has to show separate history, examination and decision making rather than repeat the study findings.
Two failure modes, opposite directions. Omit the modifier and the visit is lost. Append it to every same-day encounter and you invite a recoupment across a date range rather than one claim. Our medical coding team reads the note against the test order before the claim goes out, the only point where the decision is still free.
Supervision sits on the other side of the encounter. Diagnostic tests payable under the fee schedule must be furnished under the supervision level assigned to that code, defined at 42 CFR 410.32(b)(3) as general, direct or personal. No modifier repairs a test billed without it.
Device clinics generate predictable revenue and an equally predictable stream of frequency denials. The codes are not the hard part, the reporting intervals are.
Medicare contractor guidance is direct. CPT codes 93293, 93294, 93295 and 93296 are reported no more than once every 90 days, and not at all if the monitoring period is less than 30 days. National Government Services adds the part that catches most practices: an in-person interrogation during the same 90 day period as a remote interrogation is included in the remote service and should not be billed separately for that period.
In-person interrogation and programming codes, 93260, 93261 and 93279 through 93292, are reported per procedure. So a practice can bill both services several times a year and still be denied because two fell inside one 90 day window.
The coverage frame is older than the codes. The national coverage determination on cardiac pacemaker evaluation services places monitoring frequency with the treating physician, with prescriptions renewed at least annually. That is what a payer asks for on volume.
External ambulatory ECG monitoring is not device interrogation and does not follow these intervals. It sits under the national coverage determination on electrocardiographic services, which describes ambulatory ECG as recording over a specified period while a patient goes about daily activities. A practice running both an implantable device clinic and an external monitoring line needs two billing rules. Our full-service billing team sets that up in the first two weeks.
More cardiology money moves through the component split than through any coding decision, and it is a setup question, not a clinical one.
The PC/TC indicator is carried in the Medicare Physician Fee Schedule database and surfaced through the fee schedule look-up tool. Indicator 1 marks diagnostic tests and radiology services, the class that splits with modifier 26 and TC. Indicator 2 marks professional component only codes, 3 technical component only, and 4 global test only codes that have associated standalone codes. Indicator 9 means the concept does not apply.
A code carrying indicator 4 is not split with a modifier; a different code is used. Appending modifier 26 to a global only code does not reduce the payment, it produces a rejection.
The Medicare Claims Processing Manual, Chapter 13, pays the professional component under the physician fee schedule in all settings and handles the technical component separately. The practical rule is one matrix: for each diagnostic code, in each building, who owns the equipment and who reads the study. Own the equipment and the global service is billed. Do the study in a hospital and only the professional component is owed.
When several diagnostic imaging services are furnished in one session, the technical component of the second and subsequent services is reduced by 50%, the professional component by 25%. That changes which studies are worth scheduling together, and what an expected payment looks like before a remittance is called an underpayment.
Medical necessity sits on top through local coverage policy. Transthoracic echocardiography, cardiac radionuclide imaging and cardiovascular stress testing each have active local coverage determinations, with the covered diagnosis lists in the attached billing and coding articles. Those denials are appeals, not rebills, which is how our denials and AR recovery team works them. Appeals filed by Luxen were overturned 68% of the time.
The rule: global indicators are assigned per code in the Physician Fee Schedule relative value file, where 090 marks major surgery, 000 and 010 mark minor procedures and XXX means the concept does not apply. CMS directs billers to read the indicator from the fee schedule look-up tool rather than infer it. CMS Global Surgery Booklet, MLN907166. Cost: assume 090 and legitimate follow-up visits get suppressed for three months; assume XXX and E/M is billed inside a real global period. Coding and modifier errors caused 21% of denials.
The rule: CPT codes 93293, 93294, 93295 and 93296 are reported no more than once every 90 days, and not at all if the monitoring period is under 30 days. CMS Billing and Coding Article A56602. Cost: a recurring denial on the most predictable revenue line in the practice. 9% of device interrogation and remote monitoring claims were denied for frequency.
The rule: use XE, XP, XS or XU where one fits, reserve 59 for cases where none applies, and never use any of them to bypass an edit unless the criteria are met. CMS MLN1783722. Cost: paid claims today, recoupment later. The top three denial reasons accounted for 58% of denied dollars in the average practice.
The rule: CMS finalized two, $33.57 for qualifying alternative payment model participants, $33.40 for everyone else. CMS CY2026 Physician Fee Schedule final rule fact sheet. Cost: an expected payment table that disagrees with every remittance, so real underpayments stop being visible. 44% of practice managers could not name the fee basis in their current billing contract. Enrollment decides which factor applies, so we keep credentialing with billing.
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
We work inside the systems you already run and we do not ask anyone to migrate. On the EHR and practice management side that usually means Epic with the Cupid cardiology module, Oracle Health, athenaOne, eClinicalWorks, NextGen, Greenway or AdvancedMD. For imaging and procedure documentation, Philips IntelliSpace Cardiovascular, GE Centricity Cardio, Merge Cardio, Lumedx, ScImage PICOM365 or syngo Dynamics. Device clinics run Medtronic CareLink, Boston Scientific LATITUDE, Abbott Merlin.net, Biotronik Home Monitoring and Paceart Optima. Most charge capture failures happen between a finalized report in one of those systems and a charge in the EHR, so that reconciliation is the first workflow we build.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Luxen claim audit: 61,400 claims audited, January 2025 to June 2026. Luxen billing reviews: 410 practice billing reviews, same period.
Remote device-monitoring reports were finalized in one platform but did not always create a charge in our EHR. Luxen connected the two workflows, captured 337 missed services, and added $22,600 in monthly collections.
Practice Administrator, cardiology and electrophysiology group
Stress tests and echocardiograms were being billed without a consistent review of the professional and technical components. Luxen corrected the setup, reduced component-related rejections by 72%, and recovered $81,500.
Revenue Cycle Manager, multi-site cardiovascular practice
Full engagements are written up in our dental practice case study and our ambulance billing case study.
Four things changed for 2026 that belong in a cardiology fee schedule and forecast already.
CMS finalized separate 2026 conversion factors: $33.57 for qualifying alternative payment model participants and $33.40 for everyone else, against $32.35 in 2025. Run a single fee schedule table for all Medicare work and you will post variances that look like underpayments and are not.
CMS finalized a negative 2.5% efficiency adjustment on the work relative value units and the intraservice portion of physician time for non time-based services. Time-based codes are exempt, including evaluation and management, care management and telehealth list services. Against a cardiology charge mix: ECG, echo, stress, catheterization, ablation and nuclear codes are in scope, office visits are not.
CMS made virtual direct supervision permanent through real-time audio-visual communication for incident-to services, diagnostic tests, and cardiac and intensive cardiac rehabilitation under 42 CFR 410.49. Audio-only does not satisfy it.
The Ambulatory Specialty Model is mandatory, runs five performance years from January 1, 2027 through December 31, 2031, and covers heart failure and low back pain. The heart failure cohort is physicians specializing in cardiology, with payment adjustments from negative 9% to positive 9%. That is a data quality problem before it is a clinical one, and it starts with coding captured today. Local payer detail sits on our Florida page; the authorization layer is owned by our eligibility and prior authorization team.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections, set by charge volume, service lines and how much of the front end we own. Month to month, 30 days notice, no setup or exit fee.
Take a four-cardiologist practice collecting $3,600,000 a year with an in-office echo and stress lab plus a device clinic. At 4.5%, Luxen costs $162,000 a year.
| Line | In-house billing | Luxen |
|---|---|---|
| Salaries and benefits, three billers plus an AR specialist | $214,000 | Included |
| Clearinghouse, coding tools and payer portals | $11,000 | Included |
| Coverage during vacancy and turnover | $9,000 | Included |
| Fee at 4.5% of $3,600,000 collected | Not applicable | $162,000 |
| Annual total | $234,000 | $162,000 |
| As a share of collections | 6.5% | 4.5% |
That is $72,000 a year before any collections improvement, and the improvement is usually the larger number. Fully loaded in-house billing cost 7.9% of collections for practices under $2M across 96 practices that shared payroll data, and median days in AR dropped from 54 to 33 within 120 days. Moving off the cardiology median 47 days in AR releases cash once.
You can also compare medical billing companies by state before you shortlist.
| Partner type | Cardiology code depth | Device and imaging reconciliation | Contract |
|---|---|---|---|
| In-house team | One or two people | Manual, first to lapse in turnover | Payroll, fixed either way |
| Generalist company | General coders, many specialties | Rarely built | Percentage, often a long term |
| Specialty company | Cardiology coders | Usually built | Percentage of collections |
| EHR vendor RCM arm | Tied to the vendor platform | Only inside that platform | Bundled with the software |
| Luxen | Certified coders on cardiology work | Built in the first two weeks, imaging to EHR | 3% to 6%, month to month, no setup or exit fee |
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
The recurring families are ECG (93000, 93005, 93010), stress testing (93015 to 93018), transthoracic echocardiography (93306 to 93308 with Doppler add-ons 93320, 93321 and 93325), cardiac catheterization (93452 to 93461), ablation (93653 to 93657), nuclear perfusion imaging (78451 to 78454 and 78429 to 78434) and device monitoring (93279 to 93298). The codes are rarely the problem. Component splits and reporting intervals are.
Luxen charges 3% to 6% of collections, set by charge volume and how many service lines we take on. A practice collecting $3,600,000 a year at 4.5% pays $162,000. Fully loaded in-house billing cost 7.9% of collections for practices under $2M across 96 practices that shared payroll data.
About two weeks from signed BAA to working claims, and first recovered payments in about three weeks. Median time from signed BAA to first claims worked was 9 business days. We start on the oldest money first, so aged AR is worked while current claims keep flowing.
Yes, and there is no migration. We work inside Epic Cupid, athenaOne, eClinicalWorks, NextGen, Greenway, AdvancedMD and Oracle Health, alongside imaging systems and device platforms such as CareLink, LATITUDE and Merlin.net. Reconciling those reports against EHR charges is the first workflow we build.
It is not separately billable. Medicare contractor guidance states that an in-person interrogation during the same 90 day period as a remote interrogation is included in the remote service. Codes 93293 to 93296 are reported no more than once every 90 days, and not at all if the monitoring period is under 30 days. The check is read; the charge is held.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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