Zio is covered by many commercial insurance companies, plus Medicare

iRhythm is committed to ensuring Zio Service accessibility to every patient for whom a physician believes the monitor is medically necessary. Although insurance coverage for the Zio system is provided for many patients in-network, iRhythm remains an out-of-network provider for some patients. Our goal is to streamline your administrative process and reduce your financial risk as we manage the insurance claim processing for the Zio technical component.

We recommend you refer reimbursement questions to your internal coding expert and check with payers for policy or reimbursement changes. iRhythm provides additional resources to help you understand Zio Service coverage within your area. Please contact your local Sales Representative or iRhythm Customer Service at 1-888-693-2401, select option #4.

The Zio XT system is an extended continuous ambulatory cardiac monitor billed under procedure billing code CPT 93243 greater than 48 hours and up to 7 days, or 93247 for greater than 7 days up to 15 days.

This information is applicable to providers with whom iRhythm has arranged to submit the technical portion of the Zio Service (CPT 93243 greater than 48 hours and up to 7 days, or 93247 for greater than 7 days up to 15 days).

Zio XT is reimbursed under Category 1 CPT codes² listed below.

Application Component
when applied on-site

Billed by Ordering Physician

93242: Greater than 48 hours, and up to 7 days

93246: Greater than 7 days, and up to 15 days 

Technical Component

Billed by iRhythm

93243: Greater than 48 hours, and up to 7 days

93247: Greater than 7 days, and up to 15 days 

Interpretation

Billed by Interpreting Physician

93244: Greater than 48 hours, and up to 7 days

93248: Greater than 7 days, and up to 15 days

Medical professionals may bill for the on-site application if appropriate (93242 greater than 48 hours and up to 7 days, or 93246 for greater than 7 days up to 15 days) and the final interpretation of the results (93244 greater than 48 hours and up to 7 days, or 93248 for greater than 7 days up to 15 days). iRhythm Technologies will bill the patient's insurance for the technical component (93243 greater than 48 hours and up to 7 days, or 93247 for greater than 7 days up to 15 days).

Documentation for Zio XT reimbursement

Documentation in the medical record of the clinical rationale for prescribing Zio XT is critical to support the reimbursement process. Here are a few tips:

• Be specific when describing frequency of symptoms. Are they occurring less frequently than every 48 hours?
• Has the patient had a recent Holter monitor and what were those results? Why do you want more information?
• Specify your intent to prescribe the Zio monitor for continuous ECG monitoring including the duration of wear. Avoid using the generic term Holter.
• Specify your rationale for suspecting arrhythmia, what you are hoping to rule in or rule out with the Zio data, and any implications for the patient’s preferences and treatment plan.

In addition, documentation in the patient registration form on ZioSuite.com can support the reimbursement process.

The form contains up to four ICD-10 diagnosis fields under Billing Indications. Strengthen your medical necessity rationale by using more than one ICD-10 code to describe your patient’s condition if applicable.

The Zio AT system is a mobile cardiac telemetry billed under CPT code 93229 (technical component) and 93228 (interpretation).

Technical Component Billed by iRhythm

93229

Interpretation Billed by Interpreting Physician

93228

Documentation for Zio AT reimbursement

Documentation in the medical record of the clinical rationale for prescribing Zio AT is critical to support the reimbursement process. Documentation must include the following at minimum:

• Indication for use.
• Timing and duration of patient’s chief complaint.
• Previous cardiac monitoring.

Medical records should be uploaded to ZioSuite.

Records may also be faxed upon request to 1-415-757-3078.

Insurance coverage varies from payer to payer, contact our Patient Financial Navigator about your specific plan at 1-888-693-2401, select option #4 or contact us.

Medicaid programs vary by state. Contact us at 1-888-693-2401, select option #4 to find out if Zio is a participating Medicaid provider in your state.

For more information about patient financial assistance programs, contact our Patient Financial Navigator team at 1-888-693-2401, select option #4 or, contact us.

Each rendering provider bills for the component they perform.

iRhythm bills for the monitoring period regardless of the number of Zio patches used.

iRhythm aims to provide the best clinical care to the patient, irrespective of their ability to pay, and we offer multiple payment options to ease the financial burden. We encourage your patients to call their insurance company directly to obtain benefit details. Patients should be prepared to share the following with their insurer:

• The Zio XT system is an extended continuous ambulatory cardiac monitor billed under procedure billing code CPT 93243 greater than 48 hours and up to 7 days, or 93247 for greater than 7 days up to 15 days.
• The Zio AT system is a mobile cardiac telemetry billed under CPT code 93229 (technical component) and 93228 (interpretation).
• The diagnostic test is performed by iRhythm Technologies, Inc. National Provider Identification (NPI) # is 1710130539.

If their insurance considers iRhythm an out of network provider, patients should then call iRhythm Customer Service at 1-888-693-2401, select option #4 to discuss payment options before mailing back their Zio monitors. These options include a discounted self-pay price, financial assistance to patients for whom a balance would be a hardship, and monthly payment plans.

iRhythm Financial Navigators can provide assistance to patients throughout the billing process. For any questions about billing and reimbursement, patients should call 1-888-693-2401, select option #4.

Traditional Medicare Patients:
The Zio system is covered by Medicare³ nationwide.

Patients with Commercial Insurance:

All major commercial insurance plans cover the Zio system. Depending on their plan and benefits, patients may have an out-of-pocket responsibility. The amount owed is determined by the patient’s insurance company and can vary, comprised of a co-pay, co-insurance, or deductible. Contact iRhythm, your local Sales Representative, or Revenue Cycle Business Partner for additional details about iRhythm insurance coverage and contracts.

• Please note that documentation of medical necessity as outlined in each payer policy may be required for coverage.
• Patients will receive an Explanation of Benefits (EOB) prior to the bill from iRhythm. The EOB is not a bill and may not represent the actual amount owed by the patient as iRhythm may submit coverage appeals on behalf of the patient.