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6.3.69 Wearable Cardiac Defibrillator (WCD)
A WCD (procedure codes 93292, 93745, and K0606) are a benefit of Texas Medicaid.
The rental of a WCD (procedure code K0606) is limited to once per month and must be submitted with modifier RR.
Modifier 25 may be used to identify a significant separately identifiable evaluation and management service performed for different distinct reasons (for example, different diagnosis) on the same day as the initial set up of a WCD by the same provider for the same client. When billing with Modifier 25, the provider must provide documentation to substantiate the use of the modifier in order for services to be considered for reimbursement. Documentation includes, but is not limited to, office or hospital medical records such as history and physical progress notes, and lab results if applicable.
Procedure code 93292 will be denied as part of procedure code 93745 when submitted on the same date of service by any provider.
Procedure codes 93000, 93005, 93010, 93040, 93041, and 93042 will be denied as part of procedure code 93745 when submitted on the same date of service by any provider.
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