And, our Patient Financial Navigators are here to help your patients understand their benefits and provide guidance throughout the process.
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 93% of patient’s 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, local Revenue Cycle Business Partner at RCBP@irhythmtech.com, or iRhythm Customer Service at 1-888-693-2401, select option #4.
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 in the medical record of the clinical rationale for prescribing Zio XT is critical to support the reimbursement process. Here are a few tips:
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).
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:
Medical records should be uploaded to ZioSuite.
Records may also be faxed upon request to 1-415-757-3078.
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:
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 Medicare 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.
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.