Cardioversion is a common and necessary treatment for restoring normal heart rhythm. For physicians and billing teams, CPT code 92960 is standard for elective external cardioversion. However, billing mistakes with this code are still common, according to CMS audit reports; up to 9% of cardioversion claims were refused in 2024-2025 due to coding or documentation errors. This causes delayed reimbursement and compliance issues for providers.
In 2025, the Medicare Physician Fee Schedule shows a 2.83% decline in the conversion factor (from $33.2875 to $32.3465), which has an immediate impact on cardiovascular reimbursement and other cardiac procedures. For CPT 92960, the typical Medicare facility reimbursement is approximately $123.56, based on a total RVU of 3.63. These figures show the importance of precise reporting in long-term revenue cycle management.
Compliance regulations are also strengthening. According to the National Correct Coding Initiative (NCCI) 2025 update, 92960 should not be coded for emergency defibrillation or when conducted as part of another surgical ablation technique unless documented as a separate and unique experience. Avoiding denials, providers, coders, and compliance officers must ensure that their procedures are consistent with the amended standards.
What is CPT Code 92960?
CPT code 92960 is used to report elective external electrical cardioversions. This procedure corrects irregular cardiac rhythms such as atrial fibrillation and flutter. From a billing perspective, the code ensures that providers and facilities receive sufficient reimbursement when documentation supports the service.
CPT Code 92960 Description
The American Medical Association’s (AMA) CPT manual defines 92960 as cardioversion, elective, electrical conversion of arrhythmia; external. It is used when a doctor administers an electrical shock through chest electrodes under controlled settings to restore a normal sinus rhythm.
Key points about the description include:
Elective: The procedure is scheduled, not an emergency defibrillation.
External: External shocks are delivered using pads or paddles on the chest wall.
Single session: Multiple shocks are registered with a single unit of 92960.
Professional vs. facility billing: Physicians bill the professional component, whereas hospitals and ASCs may bill the facility cost.
Procedure Scope and Clinical Use
CPT 92960 is specific to cardioversion carried out outside of urgent resuscitation. It is typically used for:
- Atrial fibrillation.
- Atrial flutter.
- Supraventricular tachycardia is insensitive to medicines.
Clinically, the service is provided at hospitals, ambulatory surgery facilities, and physician offices equipped with monitoring capabilities. The scope does not include implanted cardioverter-defibrillator (ICD) discharges or intraoperative shocks during ablation, which are classified individually.
Documentation Requirements for CPT Code 92960
Clear documentation is required for accurate billing and defending claims during payer audits. Missing or partial information frequently results in denials or delayed payments.
Key Elements to Document
Providers must verify that the record contains all of the required components to support CPT code 92960. The following information is essential:
- Diagnosis: Type of arrhythmia.
- Procedure details: Procedure data include the indication for cardioversion, consent acquired, and the day and time of service.
- Sedation and anesthesia: Medications used, dose, and monitoring methods.
- Shock delivery: Stress delivery parameters include the number of shocks delivered, the energy level employed, and the type of equipment.
- Outcome: Whether sinus rhythm was restored and any complications occurred.
- Provider signature: Authentication by the performing physician.
Common Documentation Errors
Common mistakes in cardioversion documentation prevent claim approval. Medicare audit results for 2025 show that about 11% of rejected claims for 92960 were due to documentation inadequacies. The most common concerns are:
1. Missing indication: Failure to properly document the arrhythmia diagnosis.
2. Incomplete sedation record: missing drug, dosage, or monitoring information.
3. Outcome not recorded: No post-procedure rhythm status.
4. Confusion with defibrillation: reporting 92960 for emergency defibrillation.
5. Unsigned notes indicate a lack of source verification or electronic signatures.
ICD-10 Codes Linked with CPT Code 92960
If considered medically necessary, CPT code 92960 must be backed by accurate ICD-10 codes. Insurers need consistency between the arrhythmia diagnosis and the operation.
Commonly Used ICD-10 Codes Linked With CPT Code 92960
For 2025, the following ICD-10 codes are typically associated with 92960 cardioversion billing:
| CD-10 Code | Diagnosis Description | When to Use |
| I48.0 | Paroxysmal atrial fibrillation | Sudden AFib episodes that start and stop without intervention. |
| I48.1 | Persistent atrial fibrillation | Heart failure lasting longer than 7 days required cardioversion. |
| I48.2 | Chronic atrial fibrillation | Long-standing AFib not resolved by treatment. |
| I48.91 | Unspecified atrial fibrillation | Only when clinical details are incomplete. |
| I47.1 | Supraventricular tachycardia | Rapid rhythm from atria or AV node. |
| I47.2 | Ventricular tachycardia | Abnormally fast rhythm in the ventricles. |
| I49.01 | Ventricular fibrillation | Disorganized ventricular activity needs urgent correction. |
| I49.9 | Cardiac arrhythmia, unspecified | Use as a last resort when no specific diagnosis is documented. |
92960 Cardioversion Billing and Coding Guidelines
Correct billing for cardioversion avoids claim denials and compliance issues. Coding teams must use CPT 92960 precisely, ensuring that it accurately reflects the service being reported.
Professional and Facility Billing
CPT 92960 applies to both physician and facility claims, although each has a unique billing process. Physicians record professional services, whereas facilities claim charges for space, staff, and equipment.
When services are divided, the modifiers -26 (professional) and -TC (technical) determine the task. Multiple shocks in a single session are billed as a single unit to prevent over-reporting.
Coding Guidelines and Payer Rules
The proper use of CPT 92960 is crucial for payer acceptability. In 2025, CMS will continue to define it as medically required if clinical documentation is provided.
Providers must avoid billing errors, such as comparing cardiac arrest with cardioversion. Follow-up visits may be invoiced individually if documented within a zero-day worldwide period.
CPT 92960 Reimbursement Guidelines
The reimbursement for CPT 92960 varies depending on the payer and service location. Avoiding delays, providers and billing staff must ensure that claims comply with existing Medicare and commercial payer requirements for 2025.
Medicare Reimbursement in 2025
CPT 92960 is assigned a nationwide payment rate by Medicare as part of the Physician Fee Schedule. Key points include:
| Category | Details (2025) |
| CPT Code | 92960 – Elective external cardioversion, 1 procedure |
| Medicare Physician Fee Schedule (MPFS) | Approx. $131 – $145 (national average, varies by locality) |
| Facility Payment | Paid separately to hospitals/ASCs for staff, equipment, and room resources |
| Professional Component (-26) | Covers the physician’s professional service, interpretation, and supervision |
| Technical Component (-TC) | Covers the facility’s cost of equipment, staff, and supplies used |
| Global Period | 0 days – follow-up care billed separately |
| Prior Authorization | Not required under Medicare, but some Medicare Advantage plans may apply restrictions |
| ICD-10 Linkage | Must connect to a covered arrhythmia diagnosis (e.g., I48.0 – Paroxysmal Atrial Fibrillation) |
Conclusion
Accurate reporting of CPT code 92960 is crucial for easy reimbursement and in accordance with payer criteria. Service providers, coders, designers, and billing teams must use the code only when there is proper documentation to support it. Errors in ICD-10 linkage, modifier use, and procedure information will continue to drive denials in 2025.
Following CMS and commercial payer guidelines reduces financial risk and audit exposure. With consistent documentation and accurate claim submission, practices can maintain revenue while providing required patient care.
FAQs
What is CPT code 92960 used for?
CPT code 92960 is used to report elective external cardioversion, a procedure that restores normal heart rhythm in conditions such as atrial fibrillation or flutter.
Can CPT 92960 be billed for emergency defibrillation?
No, 92960 should not be billed for emergency defibrillation. It only applies to scheduled, elective external cardioversion procedures.
How is professional vs. facility billing handled for CPT 92960?
Physicians bill for professional services, while hospitals or ASCs bill separately for facility costs, equipment, and staff resources.
What ICD-10 codes are commonly linked with CPT 92960?
Common ICD-10 codes include I48.0 (paroxysmal atrial fibrillation), I48.1 (persistent AFib), I47.1 (supraventricular tachycardia), and I49.01 (ventricular fibrillation).
What are the Medicare reimbursement rates for CPT 92960 in 2025?
In 2025, the national Medicare Physician Fee Schedule indicates an average reimbursement of about $131–$145, depending on locality and billing component.
