First #DontDissTheHis post I can find in the EP record: 19 January 2017. Nine years later, conduction system pacing (His / LBB area) is still billed like a routine RV lead. No dedicated CPT. No differential payment for a harder implant that preserves native activation. Hardware costs less than a CS-LV / BiV CRT stack. Patient benefit is better physiology than RV apical pacing and, in the right patient, a cleaner alternative to coronary-sinus BiV. System value is fewer pacing-induced cardiomyopathies and fewer non-responders. Starting a renewed push for coverage and reimbursement that matches the work, the evidence, and the value. Please share your perspective so we can finally get this done. ✅ #DontDissTheHis #EPeeps #CSP

10/ Final rule expected early November. If you're a physician or a monitoring vendor trying to figure out what this means for your program, DMs open.

9/ RPM valuation: CMS admits it has "very little invoice or pricing information" and proposes -12.8% on 99454 and -20.6% on 99470 anyway. If you're a vendor, send invoices. I asked for a formal invoice window before any revaluation.

8/ The good news: G2211 becomes a modifier worth 16% of the E/M (32% in an ACO). Better for 99214/99215-heavy cardiology than a flat $17. Asked CMS to say plainly that specialists managing a single serious condition qualify.

7/ Code values: LAAO 33340 proposed -19%. Coronary IVUS/OCT 92978/92979 proposed -20%. TTVI/T-TEER well below RUC. All on "survey time went down," ignoring intensity. Asked CMS to accept the RUC values.

6/ Modifier 25: CMS wants to pay the E/M at 50% when it's the same day as a 0/10/90-day global. Same-day cardioversion or loop recorder after a visit gets cut. Same services on consecutive days pay in full. And they asked about extending it to inpatient E/M.

5/ Device monitoring (93294-93299) isn't in the RPM proposal, but CMS's language about outsourced monitoring "fragmenting care" describes the device RM model exactly. I asked CMS to state in the final rule that the RPM conditions don't apply to device interrogation.

4/ Withdraw the RPM "employed staff only" rule. CMS wants RPM paid only if the nurse reviewing data is a W-2 employee of the practice. Incident-to never required that. No other code family has this test. It ends RPM for most independent cardiology groups on Jan 1.

3/ Fix: classify remote monitoring as a screening service (it screens for device malfunction, new arrhythmia, HF decompensation) so it's furnished without coinsurance. Or say in writing that physicians can waive it. HRS calls this Class I standard of care.

2/ Stop billing patients for remote monitoring. ICD + PA sensor patient on traditional Medicare gets a coinsurance bill every 91 days, every 31 days, and every 30 days if on RPM. They disconnect. MA and dual-eligible patients, who owe nothing, stay on.

1/ Filed my comment on the CY 2027 Medicare Physician Fee Schedule today (CMS-1848-P). 7 pages, all cardiology. Here's what I asked for. 🧵

92 months in prison for telemarketing scheme leading to medically unnecessary expenses.

Surgeon longevity

70-year old doctor, 40 months in prison for profiting just $37k related to false billing. TAKE AWAY: don’t bill inappropriately, if you don’t understand a reg… exercise due diligence before submitting any claims. If it’s cardiology or remote care management… who’s your boy? Www.cardiologycoder.com

New multisociety consensus statement (SCAI/ASE/HRS/SIR/SVS, July 2026) confirms what we’ve been saying: heavy lead aprons are a leading cause of orthopedic injury in the cath lab — 62-66% of physicians and techs report symptoms from apron wear. OrthoVest transfers that weight from your spine to your hips — engineered relief for the workforce carrying the burden every day. myorthovest.com doi.org/10.1016/j.jscai.2026… #EPeeps #CardioTwitter #SCAI

🚨 Breaking: CMS Drops Major RPM Changes in 2027 PFS Proposed Rule Key proposals: • Restructuring + revaluation of RPM codes → potential reimbursement cuts (lower device costs + removed PE inputs) • Limits on who can furnish services: Only in-house employed staff — third-party partners out • New required initiating visit for RPM/RTM + established patient rules tightened Big implications for remote monitoring programs. Comment period open — changes not final yet. What do you think? #RPM #Medicare #PFS2027

This one is definitely worth a thousand words. I’m going to share them soon. #HRS2026 #epeeps #cardiotwitter

Your back pain isn't "just part of the job." It's physics. And it's preventable. Take the Global Lead Apron Survey (GLAS) 4 minutes to complete, your voice = industry change. LIVE NOW: myorthovest.com/survey If you wear lead, take this. #CardiacCathLab #EPeeps #HRS2026 #OrthoVest