Pacemaker and ICD remote monitoring is the routine review of data that an implanted pacemaker or implantable cardioverter-defibrillator (ICD) sends from the patient's home to their device clinic. The device transmits on a schedule and whenever it detects an alert condition. The clinic reviews each transmission, escalates what needs a physician, documents the findings and bills the service with CPT 93294, 93295 and 93296.
Key Takeaways
- Pacemakers and ICDs send data through a bedside monitor or smartphone app to the manufacturer's network, where the device clinic reviews it.
- Every transmission shows device function (battery, leads, pacing) and recorded rhythm events. ICD transmissions also show any therapy delivered, including shocks.
- Heart Rhythm Society (HRS) expert consensus recommends remote monitoring for patients with cardiac implantable electronic devices (CIEDs), alongside in-person checks after implant and at least once a year.
- Remote interrogation is billed once per 90 days: 93294 for pacemakers or 93295 for ICDs, each paired with 93296 for the technical work.
- The hardest part for most clinics is volume: alerts to triage, monitors that stop transmitting, and a separate portal for each manufacturer.
What Is Pacemaker and ICD Remote Monitoring?
Pacemakers and ICDs are both cardiac implantable electronic devices, or CIEDs. A pacemaker treats slow heart rhythms by pacing the heart. An ICD watches for fast, dangerous rhythms and can pace or shock the heart back into a normal rhythm, and most ICDs also pace. Cardiac resynchronization devices (CRT-P and CRT-D) are followed in the same programs.
Remote monitoring lets the device clinic see how the device and the patient's heart rhythm are doing between office visits, without the patient travelling. It applies to traditional transvenous systems, leadless pacemakers and subcutaneous ICDs, although the hardware each one uses to transmit differs by model.
How Does Pacemaker Data Get From the Device to the Clinic?
- The implanted device stores measurements and events, then sends them wirelessly to a bedside monitor or a smartphone app.
- The monitor or app forwards the transmission to the manufacturer's secure network.
- The clinic opens it in that manufacturer's portal, or in a vendor-neutral platform that collects transmissions from every portal into one queue.
- A trained cardiac device specialist triages the transmission. A physician or qualified health care professional reviews and signs the report, which is then filed in the electronic health record (EHR).
A clinic that follows patients with devices from all four manufacturers works across four portals, each with its own alert settings and report format, unless it uses a vendor-neutral platform.
What Does a Pacemaker or ICD Transmission Show?
A full remote interrogation gives the clinic most of what an in-office device check reads, apart from tests that need the patient present or a programming change.
How Often Should Pacemaker and ICD Patients Transmit?
Transmissions come in two kinds. Scheduled transmissions are full device checks sent on a set calendar, and many clinics schedule one every 91 days so each check falls inside a 90-day billing period. Alert transmissions arrive whenever the device detects a condition the clinic has programmed it to report, such as a long AF episode, an abnormal lead measurement or an ICD shock.
The 2015 HRS expert consensus statement on remote interrogation and monitoring recommends an in-person evaluation within 2 to 12 weeks of implant, followed by remote monitoring combined with at least one in-person evaluation a year. The 2023 HRS expert consensus statement on the practical management of the remote device clinic sets out how clinics should staff, triage alerts and educate patients for that ongoing remote follow-up.
What Happens When a Pacemaker or ICD Alert Comes In?
Each clinic sorts alerts into categories in a written protocol signed off by its physicians, with a response time for each. A common structure has three levels:
After an ICD shock, the reviewer checks the stored electrograms to judge whether the shock treated a dangerous rhythm or was inappropriate, for example from AF or a lead problem, then follows the clinic's protocol for contacting the patient.
How Is Pacemaker and ICD Remote Monitoring Billed?
Each code is reported once per 90-day period and needs at least 30 days of monitoring. 93294 and 93295 are never reported together for the same device and period. The full rules, documentation requirements and FAQs are in our cardiac remote monitoring CPT codes guide.
Where Device Clinics Struggle With Remote Monitoring
Alert volume. Every transmission has to be reviewed and documented, whether or not it needs action. In one large multicenter cohort, more than half of patients sent at least one alert in a year, for over 82,000 alerts in total.
Monitors that stop transmitting. Patients unplug bedside monitors, change phones or travel. A patient who isn't transmitting isn't being monitored, and a period with fewer than 30 days of monitoring can't be billed.
Several portals. Each manufacturer has its own portal, alert settings and report layout, so staff re-key data and track patients across systems.
Billing windows. Each patient's 90-day period starts on a different date, and a missed or mistimed claim is lost revenue for the clinic.
The remote monitoring guidelines for device clinics post covers how HRS expects clinics to handle these pressures.
How Octagos Runs Pacemaker and ICD Remote Monitoring
Octagos is a vendor-neutral remote cardiac monitoring platform and clinical service. Transmissions from each manufacturer arrive in one queue. Atlas AI™ triages every transmission, and in the Two-Brain Approach™ an IBHRE-certified cardiac device specialist reviews it before the report goes to the physician for signature.
In a study published in JACC: Advances covering 690,673 transmissions from 78 US clinics, Atlas AI triage reached 99.1% sensitivity and forwarded about 40% fewer transmissions to clinics than technician review.
Signed reports post to the clinic's EHR through bi-directional EHR integration. Octagos tracks each patient's 90-day period so claims go out in the right window, and follows up with patients whose monitors stop transmitting. For more on the transmission pipeline, see how cardiac remote monitoring works.
See how Octagos handles pacemaker and ICD remote monitoring. Book a demo.
Frequently Asked Questions
Can a doctor tell if a pacemaker is working remotely?
Yes. A remote transmission shows battery status, lead measurements and how often the device is pacing, so the device clinic can confirm the pacemaker is working without an office visit. Changing the pacemaker's settings still requires an in-person visit.
Does remote monitoring replace in-person device checks?
No. HRS expert consensus recommends an in-person check within 2 to 12 weeks of implant and at least once a year after that, with remote monitoring in between.
Does Medicare cover pacemaker and ICD remote monitoring?
Yes. Medicare pays for remote interrogation under CPT 93294 or 93295 with 93296, once per 90 days. The patient's usual Part B cost-sharing applies.
What happens if a patient's monitor stops transmitting?
The clinic contacts the patient to reconnect the monitor or app. Until it reconnects, the clinic receives no data, and a period with fewer than 30 days of monitoring can't be billed.
Do leadless pacemakers and subcutaneous ICDs support remote monitoring?
Yes. Both can be followed remotely and are billed with the same codes: 93294 for leadless pacemakers and 93295 for subcutaneous ICDs. The transmitting hardware, a bedside monitor or a smartphone app, depends on the model.
Sources: 2015 HRS expert consensus statement on remote interrogation and monitoring for cardiovascular implantable electronic devices (Heart Rhythm); 2023 HRS/EHRA/APHRS/LAHRS expert consensus statement on practical management of the remote device clinic (Heart Rhythm); AMA CPT® code set; CMS Medicare Physician Fee Schedule; Role of Artificial Intelligence in Reducing Data Deluge From Cardiac Implantable Electronic Devices (JACC: Advances, 2025). This article is general information and is not clinical or billing advice.