Skip to Main Content
Stay Connected on the Go! Download our Health Insurance Portal mobile app to search for care, view benefits and access your Member ID card. LEARN MORE AND DOWNLOAD THE APP
Stay Connected on the Go! Download our Health Insurance Portal mobile app to search for care, view benefits and access your Member ID card. LEARN MORE AND DOWNLOAD THE APP

Provider Guidance: EKG Screenings Now Required for Student Athletes

Date: 04/22/26

Sunshine Health is committed to helping our providers deliver high-quality, preventive care. To support those efforts, here’s important guidance about a new Florida law that impacts student athletes and the healthcare they receive.

The Second Chance Act requires all Florida high school athletes in the upcoming 2026-2027 school year to undergo an electrocardiogram (EKG) to help identify underlying heart conditions before they are allowed to compete in sports activities.

The goal of the new law is to prevent sudden cardiac arrest (SCA), which is the leading cause of death in young athletes and can be caused by an undiagnosed heart condition.

The following students must complete at least one EKG:

  • Incoming ninth grade student‑athletes
  • Students in grades 10–12 who have never previously participated in a sport sanctioned by the Florida High School Athletic Association (FHSAA), which governs all interscholastic sports in the state

An EKG performed two years before the start of the 2026–27 school year satisfies this requirement. Students with abnormal EKG findings may not participate in sports until obtaining written medical clearance.

This requirement establishes statutory medical necessity for the EKG as part of the sports participation evaluation.

Billing Guidance for Sports Physicals

Sports Physical Performed as Part of an Annual Preventive Visit

When the pre‑participation physical evaluation (PPE) is completed during an age‑appropriate well‑child or adolescent preventive visit, providers should bill the appropriate preventive medicine E/M code, based on age and patient status:

  • 99384 / 99394 – Adolescent preventive visit (ages 12-17 years)
  • Other 99381–99397 codes – As age‑appropriate

Note: There is no separate CPT code for a “sports physical.” When performed as part of a comprehensive preventive visit, sports clearance is considered included in the preventive service.

Stand‑Alone Sports Physical (No Preventive Visit)

If a PPE is performed outside of a routine preventive visit:

  • Providers may bill the appropriate office E/M code (99202–99215) based on documentation and medical decision‑making.
  • Coverage for stand‑alone sports physicals is payer‑specific and may be limited.

Billing Guidance for Required EKG

CPT Codes

When an EKG is performed to comply with Florida law, bill the applicable CPT code based on the service rendered:

  • 93000 – Electrocardiogram, routine ECG with interpretation and report
  • 93005 – Electrocardiogram, tracing only
  • 93010 – Electrocardiogram, interpretation and report only

Diagnosis Codes

To support medical necessity and claims adjudication, use diagnosis codes consistent with the statutory screening requirement:

  • Z13.6 – Encounter for screening for cardiovascular disorders
  • Z02.5 – Examination for participation in sport (may be reported as secondary)

Note: An EKG is no longer considered an elective or discretionary screening when performed to satisfy Florida’s statutory sports participation requirement.

EKG and Preventive Visits

When the EKG is performed on the same date as a preventive visit, the EKG may be separately reportable if allowed by the payer.

Providers should ensure documentation reflects:

  • The state‑mandated requirement, and
  • That the EKG is performed for sports participation clearance.

Abnormal EKG Results

  • Abnormal EKG findings require further evaluation and/or referral, typically to pediatric cardiology.
  • Students may not participate in school athletics until obtaining written medical clearance per state law and FHSAA bylaws.

Best Practices

To reduce claim denials and support payment:

  • Reference the Florida statutory requirement in the assessment/plan when ordering or performing the EKG.
  • Document that the EKG is required for school sports participation.
  • Use the most current, accepted standards for EKG interpretation in athletes, as recommended by FHSAA guidance.

Resources

If you have any questions, please contact your Provider Engagement Account Manager (PEAM) or call Provider Services at 1-844-477-8313.

Questions?

Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:

SH_11696