Wiki 93293 pacemaker billing Medicare

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I have a question regarding billing Medicare for cpt code 93293 pacemaker evaluation. According to the 2009 cpt manual this code can only be reported once per 90 days. Is there any exception to this? Is there a modifier that can be added if patient's pacemaker's life expectancy is approaching, can we report this code every 30 days? Can notes be submitted showing medical necessity?
Thanks,
Susan Maruska
 
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