CPT Code 93285Complete Billing & Coding Guide (2026)Prgrmg dev eval scrms ip
About CPT 93285
CPT 93285 is a Current Procedural Terminology code in the Cardiovascular category maintained by the American Medical Association. The CMS short descriptor reads "Prgrmg dev eval scrms ip". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
Documentation specificity, correct ICD-10 linkage, and modifier accuracy determine whether 93285 pays cleanly or triggers a denial. Verify CMS National Physician Fee Schedule status, applicable Medicare LCDs, and any payer-specific medical policies before submission.
93285 has 10 NCCI bundling edit pairs documented. Run your scrubber against the NCCI quarterly update before submission. When clinically warranted, use modifier 59 or the X-modifiers (XE, XS, XP, XU) to bypass an indicator-1 edit, with chart documentation supporting the distinct service.
Code Properties
RVU Breakdown
Every CPT code’s Medicare payment is calculated from three Relative Value Unit components: physician work, practice expense, and malpractice. Together they multiply by the conversion factor to produce the payment amount.
Payment = Total RVU × Conversion Factor ($33.4009) × Geographic Adjustment (GPCI). National averages shown. Actual payment varies by locality.
Medicare Payment by State
Medicare adjusts payment by locality based on GPCI (Geographic Practice Cost Index). Higher cost-of-living areas like California and New York pay more. Rural states pay less. Top 12 states shown.
Showing top 12 of 53 states. Full locality data available in CMS PFS Locality file.
NCCI Bundling Edits
10 pairsThese codes trigger National Correct Coding Initiative edits when billed with 93285. An indicator of 0 means the pair cannot be unbundled. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with supporting documentation.
93285 + 0571T: hard bundle (indicator 0)
The most-asked bundling question on this code. Verdict pulled from the current NCCI quarterly file.
Modifier indicator 0 means this edit cannot be bypassed. Do not append modifier 59 or X-modifiers. The bundled code must be written off, or, if clinically inappropriate, the entire claim reconsidered.
CPT Manual or CMS manual coding instruction
Billing 93285 alongside a bundled code without the correct modifier generates CARC 97 denials. Payers often flag these as audit risks. Document medical necessity for the separate service and apply modifier 59 or the appropriate X-modifier (XE, XS, XP, XU) only when clinically justified.
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
CPT Manual or CMS manual coding instruction
Bundling denials on 93285 are recoverable when the edit indicator is 1 and the chart documents a distinct, separately identifiable service. Our coders verify the indicator and pick the precise X-modifier (XE, XS, XP, XU) instead of defaulting to modifier 59.
Got a CO-97 on 93285 and 0571T? Send us the EOB before you write it off.
Indicator 0 means no modifier bypasses the edit. A real coder should confirm before the charge is written off. Some look-alike edits get appealed successfully on documentation grounds.
Remove patient name, DOB, and member ID before pasting.
Applicable Modifiers
Modifiers commonly paired with 93285 based on its category. Apply only when the clinical circumstance warrants. Incorrect modifier use is a top audit target.
Modifier audits catch what scrubbers miss. Our AAPC-certified team reviews every modifier choice on 93285 against the chart documentation before submission, surfacing missed and misapplied modifiers across the practice.
Find the revenue leakage in your 93285 claims.
Wrong modifier, missing documentation, bundling without justification, stale ICD-10 linkage: these are the silent revenue killers on Cardiovascular claims. Our AAPC-certified team audits your last 90 days of 93285 claims, surfaces the recoverable dollars, and appeals them. Free, no obligation.
Losing revenue on CPT 93285? We’ll find it.
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Related CPT Codes
Codes in the same family as 93285
Everything about CPT 93285
What does CPT code 93285 cover?
CPT 93285 is a Current Procedural Terminology code in the Cardiovascular category maintained by the American Medical Association. The CMS short descriptor reads "Prgrmg dev eval scrms ip". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
What is the Medicare payment for CPT 93285?
The national average Medicare payment for CPT 93285 is approximately $59.45 in a non-facility setting and $59.45 in a facility setting. Actual payment varies by locality based on GPCI adjustments. Total RVU is 1.78 with a conversion factor of $33.4009.
What is the global period for CPT 93285?
CPT 93285 has no global period (indicator XXX). There are no post-operative day restrictions tied to this code. Refer to CMS National Physician Fee Schedule rules and any applicable NCCI edits when billing on the same date as other services.
What codes bundle with CPT 93285?
CPT 93285 has NCCI Procedure-to-Procedure edits with 10+ codes including 0571T, 0572T, 0573T. Modifier indicator 0 means the edit cannot be bypassed. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with documentation.
CPT codes and descriptions are copyright of the American Medical Association. RVU values reflect current CMS publications. Actual payment varies by locality. Commercial payer rates vary by contract.
Free 90-Day AR Recovery Audit
We audit your last 90 days of claims and surface the revenue leakage: wrong modifiers, missed bundling appeals, ICD-10 specificity gaps. AAPC-certified coders. 2.49% of collections. No setup fees.