Key takeaways
- CPT 93015 is the complete stress test. 93016, 93017 and 93018 are its three parts: supervision, tracing and interpretation with report.
- One practice doing all three parts bills 93015. When different parties do different parts, each bills only its own code.
- Medicare contractors pay stress testing only when the record shows why it was done and why now. Noridian also limits how often it repeats.
What the four stress test codes mean
A cardiovascular stress test has three parts: the physician supervision of the test, the recording of the tracing, and the interpretation and written report. CPT gives each part its own code and one code for all three together.
| CPT | What it covers | Who bills it |
|---|---|---|
| 93015 | Complete test: supervision, tracing, interpretation and report | One practice that does every part |
| 93016 | Physician supervision only | The physician who supervised |
| 93017 | Tracing only | The site that owns the equipment and records the test |
| 93018 | Interpretation and report only | The physician who reads and reports |
The common loss is a split that does not match who did the work. A practice that owns the treadmill but sends the tracing to an outside reader should bill 93017, not 93015. A cardiologist who only reads a hospital test bills 93018.
What the medical record has to show
Noridian Medicare publishes a billing and coding article for cardiovascular stress testing that supports its local coverage policy L34324. It covers exercise and pharmacological stress and stress echocardiography. The record has to support medical necessity, and the article lists what to document:
- The clinical diagnosis and the specific reason for the study.
- The referral order, written or verbal, with date, referring physician and reason.
- Why pharmacological stress was used, when it was.
- Why a stress echo was done instead of an electrical stress test, and why, if a nuclear test is also done for the same condition.
- An interpretation of every segment of the service, such as both the electrical and echo results.
- The need for the test frequency, and the required physician supervision, ideally on the test report.
How often Medicare will pay for a repeat
The same Noridian article says stress testing is covered only at a frequency that fits the patient's condition and only when the result could change treatment. Routine follow-up after a heart attack, bypass or angioplasty is not reasonable and necessary without symptoms or a clinical indication. Annual testing without an individual reason is not covered either. Where the record is enough to monitor a patient reliably, one follow-up test every five years may be sufficient. Patients with silent coronary disease may need testing as often as yearly.
These are one contractor's rules, for Noridian jurisdictions E and F. Other Medicare contractors and commercial payers publish their own policies, so check yours before you bill.
Mistakes that cause denials
- Billing 93015 when the reading is done elsewhere. The claim claims work your practice did not do.
- A diagnosis that does not match the policy. The Noridian article lists roughly 594 supporting diagnosis codes. A symptom code outside the list is denied.
- Missing order or reason for the test. A test with no referral on file cannot be defended in an audit.
- Repeating a test too soon. Without a documented change in condition, the second test is denied as not necessary.
- No supervision statement. Put the supervising physician on the report.
Sources
Medical necessity, documentation and frequency rules: Medicare Coverage Database, Billing and Coding Article A57183, Cardiovascular Stress Testing (Noridian). The four CPT code definitions are from the AMA CPT code set. Check your own contractor and each commercial payer for current policy.
Cardiac stress test billing questions
What is the difference between CPT 93015 and 93016, 93017 and 93018?
93015 is the complete stress test and includes supervision, tracing, and interpretation with report. 93016 is supervision only, 93017 is the tracing only and 93018 is the interpretation and report only. The three parts are billed separately only when different parties do them.
When do I bill 93015 instead of the separate codes?
Bill 93015 when one practice supervises the test, records the tracing and does the interpretation and report. If a hospital owns the equipment or an outside physician reads the result, each party bills only the part it performed.
What does Medicare require to pay for a stress test?
The record must show the diagnosis and the reason for the test, the referral order, the reason for any pharmacological or echo stress, an interpretation of every segment, and physician supervision. Noridian also ties payment to test frequency that fits the patient's condition.
How often will Medicare pay for a repeat stress test?
Under the Noridian policy, routine annual or post-procedure testing without symptoms or a clinical reason is not covered. It allows testing at a frequency suited to the condition, and one follow-up every five years may be enough when the patient can be monitored reliably. Other contractors have their own policies.