Put ZIO cardiac monitoring to work for your patients

Put ZIO cardiac monitoring to work for your patients

Join healthcare professionals worldwide who rely on Zio. 90% of the time, Zio leads to a definitive diagnosis in a single testing period.1

1Barrett, P., et al. (2014). Comparison of 24 Hour Holter Monitoring Versus 14 Day Novel Adhesive Patch Electrocardiographic Monitoring. American Journal of Medicine.

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Integrate with your EHR

Integrate with your EHR

Designed to streamline your Zio monitoring system experience, iRhythm Integration Service centralizes workflows around your EHR system by enabling ordering and receiving of the Zio service through your EHR.

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Insurance and Billing for the Zio System

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

iRhythm is committed to ensuring Zio system accessibility to every patient for whom a physician believes the monitor is medically necessary. Although insurance coverage for the Zio system is provided for approximately 290 million lives, iRhythm remains an out-of-network provider for some patients. Our goal is to reduce your administrative burden as we manage the insurance claim processing for the Zio technical component.

We recommend that you refer reimbursement questions to your coding expert and check with payers for policy or reimbursement changes. In addition, iRhythm billing specialists are available to assist with questions related to billing. Please contact your local sales representative, Revenue Cycle Business Partner, or iRhythm Customer Service at 1.888.693.2401.

Billing for the Zio System

The Zio system is reimbursed under Category 1 CPT Codes1 listed below.

(when applied on-site)
Billed by Ordering Physician
Billed by iRhythm
Billed by Interpreting Physician
Greater than 48 hours,
and up to 7 days
Greater than 48 hours,
and up to 7 days
Greater than 48 hours,
and up to 7 days
Greater than 7 days,
and up to 15 days
Greater than 7 days,
and up to 15 days
Greater than 7 days,
and up to 15 days

Medical professionals will bill for the on-site hook-up (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).

1 CPT Copyright 2012 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the American Medical Association.

CPT Disclaimer: Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein

Disclaimer: The information contained in this document is provided for informational purposes only and represents no statement, promise or guarantee concerning levels of reimbursement, payment or charges. iRhythm Technologies, Inc. (iRhythm) makes no representation or warranty regarding this information or its completeness, accuracy, timeliness, or applicability with a particular patient. iRhythm encourages providers to submit accurate and appropriate claims for services. Laws, regulations and payer policies concerning reimbursement are complex and change frequently. Providers are responsible for making appropriate decisions relating to coding and reimbursement submissions

Documentation for Reimbursement

Documentation in the medical record of the clinical rationale for prescribing the Zio monitor 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 for up to 14 days. 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.
  • The form contains a “Clinical Notes” free-text box where you can summarize your clinical rationale for prescribing the Zio monitor. Reference the bullet points above for medical record documentation to inform your clinical note.

Patient Out-of-Pocket Expenses

Traditional Medicare Patients

The Zio system is covered by Medicare in all 50 states. 

Patients with Commercial Insurance

Many 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. The patient owes no money until a bill is received from iRhythm.

Patient Assistance Programs

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 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 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 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 Counselors can provide assistance to patients throughout the billing process. For any questions about billing and reimbursement, patients should call 1.888.693.2401.

Now, with Zio by iRhythm, you can combine innovative cardiac analysis and a simplified patient experience. A shorter path to what you and your patient both need — answers.