Before diving into the details, determine which billing process applies to your situation:

Hospital/Facility Billing – For billing facility fees in hospital outpatient settings:

• Bills for equipment, room, technical staff
• Uses standard hospital outpatient methodology
• Maps to APC 5734 with established payment rates

Provider/Professional Billing – For billing physician or other provider professional fees:

• Bills for physician interpretation and clinical decision-making
• Requires crosswalk methodology due to no established RVUs

What are you billing for?

Hospital facility fees (equipment, room, tech staff)? → Go to Section 2: Hospital Facility Billing

Physician professional fees (interpretation, clinical decisions)? → Go to Section 3: Provider Professional Billing

Both facility and professional components? → Use both Section 2 and Section 3 for respective components

CPT Codes for ECG-AI LEF:

• 0764T: Assistive algorithmic ECG analysis; concurrent with ECG (add-on code)
• 0765T: Assistive algorithmic ECG analysis; previously performed ECG (stand-alone code)

Code Selection Decision:

• Same-day ECG + ECG-AI LEF analysis: Use 0764T
• ECG-AI LEF analysis of previous ECG: Use 0765T

Hospital facility billing for ECG-AI LEF follows standard outpatient procedures using established APC methodology.

Process Characteristics:

• Standard APC methodology – Uses established Medicare payment classifications
• Established payment rates – APC 5734 provides predictable reimbursement
• Standard processing – Follows normal hospital billing workflows
• Basic documentation – Standard facility requirements
• Routine charge master setup – Treat like any other outpatient procedure

CPT Code Assignment:

• 0764T: Assistive algorithmic ECG analysis; concurrent with ECG
• 0765T: Assistive algorithmic ECG analysis; previously performed ECG

APC Classification: Both 0764T and 0765T map to APC 5734

• APC 5734: Level 4 Clinic Visits
• 2025 Payment Rate: $128.90 (Medicare national average, varies with  geographic adjustment)
• Relative Weight: 1.812
• Status Indicator: T (Procedure paid under OPPS)

Payment Structure: Hospital Outpatient Payment = Base APC Rate × Geographic Adjustment × Relative Weight

Example Calculation: $71.14 (Base) × 1.05 (Geographic) × 1.812 (Weight) = ~$135

Charge Description Master (CDM) Entries:

For 0764T:

• Description: “ECG-AI Analysis – Concurrent”
• CPT Code: 0764T
• Revenue Code: 0636 (EKG/ECG)
• APC: 5734
• Department: Cardiology/EKG Lab
• Charge Amount: [Hospital-specific rate]

For 0765T:

• Description: “ECG-AI Analysis – Previous ECG”
• CPT Code: 0765T
• Revenue Code: 0636 (EKG/ECG)
• APC: 5734
• Department: Cardiology/EKG Lab
• Charge Amount: [Hospital-specific rate]

Charge Setting Considerations:

• Cost-based approach: Calculate actual costs (equipment, staff, overhead)
• Market positioning: Consider competitive rates in your market
• Payer mix analysis: Account for different payer reimbursement levels
• Annual review: Update charges per standard hospital process

Step 1: Service Documentation

• ECG-AI LEF analysis performed and documented
• Basic clinical indication noted
• Technical quality verified
• Results communicated to ordering physician

Step 2: Charge Entry

• Select appropriate CPT code (0764T or 0765T)
• Enter via standard charge entry process
• Verify patient registration complete
• Confirm insurance information

Step 3: Billing Submission (Standard process)

• Include in routine hospital claim batch
• Use standard UB-04 claim form
• Follow normal facility billing workflow
• Apply standard edits and audits

Clinical Documentation:

• Basic indication: Why ECG-AI LEF analysis was performed
• Clinical context: Relevant patient symptoms or risk factors
• Results summary: ECG-AI LEF analysis findings
• Clinical impact: How results influenced care (brief note)

Technical Documentation:

• Service date and time
• Performing technologist (if applicable)
• Equipment used
• Quality verification completed

Administrative Documentation:

• Physician order for ECG-AI LEF analysis
• Patient consent (per facility policy)
• Insurance verification completed

Example Procedure Note Template:

ECG-AI LEF ANALYSIS – FACILITY DOCUMENTATION

Date: [MM/DD/YYYY] Time: [HH:MM] Location: [Department]

INDICATION:

☐ Cardiac risk assessment

☐ Heart failure screening

☐ Pre-operative evaluation

☐ Other: [Specify]

PROCEDURE: 12-lead ECG obtained and analyzed using Anumana ECG-AI LEF technology.

Successful Positive Result

Device Output

• Output: YES
• Displayed Result: Low LVEF Detected
• Interpretation Statement: Low Left Ventricular Ejection Fraction detected based on analysis of input ECG waveform.
• Follow-up Recommendation: Further clinical evaluation suggested in order to establish diagnosis of Low LVEF. ECG-AI Low Ejection Fraction 12-Lead algorithm analysis should be applied jointly with clinical judgment.

Device Name: ECG-AI Low Ejection Fraction 12-Lead algorithm

Unique Device Identifier: (01)00860007426445(8012)V2.4.0

Successful Negative Result

Device Output

• Output: NO
• Displayed Result: Low LVEF Not Detected
• Interpretation Statement: Low Left Ventricular Ejection Fraction NOT detected based on analysis of input ECG waveform.
• Follow-up Recommendation: This result does not rule out Low LVEF. In addition to the ECG-AI Low Ejection Fraction 12-Lead algorithm analysis, clinical judgment should be used to obtain further noninvasive evaluation of LVEF if clinically indicated.

Device Name: ECG-AI Low Ejection Fraction 12-Lead algorithm

Unique Device Identifier: (01)00860007426445(8012)V2.4.0

Unsuccessful Completion

Device Output

• Output: null
• Displayed Result: Error
• Interpretation Statement: The input ECG waveform does not meet the quality criteria and cannot be processed by the ECG-AI LEF 12-Lead algorithm.
• Follow-up Recommendation: null

Device Name: ECG-AI Low Ejection Fraction 12-Lead algorithm

Unique Device Identifier: (01)00860007426445(8012)V2.4.0

Completion

Key Fields for ECG-AI LEF:

Revenue Code Lines:

• Line 1: Revenue Code 0636 (EKG/ECG)
• HCPCS/CPT: 0764T or 0765T
• Service Date: Date of ECG-AI LEF analysis
• Units: 1
• Charges: Per charge master

Diagnosis Coding: Primary Diagnosis Options:

• I50.9 (Heart failure, unspecified)
• I25.5 (Ischemic cardiomyopathy)
• R94.31 (Abnormal ECG)
• Z13.6 (Screening for cardiovascular disorders)

Other Required Fields:

• Standard patient demographics
• Insurance information
• Attending physician NPI
• Service facility information

Claims Processing – Performance Benchmarks:

Success Factors:

• Clean documentation – Basic but complete clinical notes
• Accurate coding – Correct 0764T vs 0765T selection
• Timely submission – Standard facility billing timelines
• Proper charge capture – Consistent charge entry processes

Areas to Monitor:

• High denial rates – May indicate documentation issues
• Payment delays – Could suggest payer education needs
• Coding errors – Requires staff training
• Charge capture misses – Need process improvements

Pre-Implementation:

• Charge master setup completed
• Staff training conducted
• Documentation templates created
• Quality assurance processes established
• Payer contracts reviewed

Go-Live:

• First cases documented and billed
• Daily monitoring of charges and documentation
• Weekly review of early outcomes
• Staff feedback collection and response

Post-Implementation:

• Monthly performance review (include Anumana representative)
• Quarterly benchmarking against targets
• Annual process optimization
• Ongoing staff development

Category III CPT codes (0764T and 0765T) require specific attention:

• No assigned RVUs – Medicare and payers have not established payment rates
• No standardized coverage – Each payer decides individually
• Potential for denials – Unfamiliar codes often get denied automatically
• Documentation – Requires justification

Crosswalk billing bridges the gap by demonstrating equivalent value to established procedures. Payers are familiar with these processes.

How It Works:

1. Compare Work Effort – Analyze physician time, complexity, and decision-making
2. Document Practice Costs – Calculate equipment, staff, and administrative expenses
3. Assess Risk Factors – Evaluate malpractice and liability considerations
4. Reference Established CPT – Link to codes with known RVUs and payment rates
5. Request Fair Payment – Justify reimbursement based on equivalent procedures

Key Benefits:

• Higher Success Rates – Comprehensive justification reduces denials
• Appropriate Payment – Fair reimbursement based on actual value delivered
• Streamlined Process – Standardized approach across all payers
• Audit Protection – Complete documentation supports compliance

Phase 1: Pre-Service

• Prior Authorization – Secure payer approval when required
• Medical Necessity – Document clinical rationale
• Patient Assessment – Identify risk factors and indications

Phase 2: Service Delivery

• ECG-AI LEF Analysis – Complete clinical service
• Procedure Report – Record findings and clinical impact
• Quality Review – Verify completeness and accuracy

Phase 3: Claims Preparation

• Crosswalk Analysis – Select appropriate reference CPT code
• Complete CMS-1500 – Accurate form completion with proper coding
• Gather Documentation – Assemble all required supporting materials

Phase 4: Payer Communication

• Submit Claims – Include comprehensive justification package
• Follow Up – Track status and respond to payer questions

Appeals Process – Address denials with additional documentation

Realistic Expectations:

• Payment Rate: 60-80% of crosswalk reference code allowable
• Approval Time: 30-90 days for initial claims
• Success Rate: 70-85% approval with proper documentation
• Appeal Success: 80-90% with comprehensive justification

Factors for Success:

• Complete Documentation – All required materials included
• Strong Clinical Rationale – Clear medical necessity
• Appropriate Crosswalk – Well-justified reference code selection
• Persistent Follow-Up – Consistent payer communication

New to ECG-AI LEF Billing?

Step 1: Learn the Process

• Review the comprehensive documentation in Section 4
• Study the template examples in Section 5
• Understand the crosswalk methodology

Step 2: Prepare Your Team

• Train billing staff on crosswalk methodology
• Educate clinical staff on documentation requirements
• Establish internal protocols and quality checks

Step 3: Start with One Claim

• Select straightforward clinical scenario
• Use all templates and checklists
• Track time and outcomes for process improvement

Already Billing but Need Better Results?

Audit Your Current Process:

• Review denial patterns and reasons
• Analyze documentation completeness
• Compare your crosswalk selections

Optimize Your Approach:

• Strengthen medical necessity documentation
• Improve payer communication strategies
• Enhance clinical procedure reports