Cardiology Reimbursement Coding Fact Sheet

The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Cordis Corporation concerning levels of reimbursement, payment, or charge. Similarly, all CPT, ICD-10 and HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Cordis that these codes will be appropriate to specific circumstances or products or services provided or that reimbursement will be made. Providers are ultimately responsible for exercising their independent clinical judgment to determine medical necessity for individual patients and the appropriate billing process according to the applicable payer’s current policy. CPT codes and descriptions are copyright 2016 American Medical Association. ICD-10 codes and descriptions are copyright 2016 World Health Organization; revised for use in the United States by the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) as ICD-10-CM / ICD-10-PCS. Healthcare Common Procedure Coding System (HCPCS) Level II codes and descriptions are maintained by the CMS HCPCS Workgroup. The information contained in this document is taken from various publicly available documents, is current at the date of publication and is subject to change at any time.

CPT® Codes and Physician Reimbursement

Medicare Part B pays for physician services based upon the Medicare Physician Fee Schedule (MPFS). Fee schedule amounts are calculated according to the Resource-Based Relative Value Scale (RBRVS), which is updated each year. Procedures are reported using CPT® codes. The 2017 CPT Professional Edition Manual also provides specific instructions for reporting particular families of codes. Individual payers may also have guidelines and coverage policies regarding certain services. The following table lists the most commonly used codes for coronary procedures

Diagnostic Procedures and Imaging

CPT® Code	Description	2017 Work RVUs	2017 Medicare Base Payment Rate2
			Non-Facility	Facility
93451	Right heart catheterization	2.47	$737	$136
93452	Left heart catheterization	4.50	$839	$248
93453	Right and left heart catheterization	5.99	$1,089	$332
93454	Coronary angiography	4.54	$851	$252
93455	Coronary angiography with bypass grafts	5.29	$995	$293
93456	Coronary angiography with right heart catheterization	5.90	$1,076	$327
93457	Coronary angiography and bypass grafts, with right heart catheterization	6.64	$1,220	$368
93458	Coronary angiography with left heart catheterization	5.60	$1,025	$310
93459	Coronary angiography and bypass grafts, with left heart catheterization	6.35	$1,137	$352
93460	Coronary angiography with right and left heart catheterization	7.10	$1,225	$394
93461	Coronary angiography with bypass grafts, right and left heart catheterization	7.85	$1,402	$435
+93462	Left heart access via transseptal or transapical puncture	7.85	$219	$219
+93463	Pharmacological agent administration with hemodynamic assessment	3.73	$101	$101
+93464	Physiologic exercise study with hemodynamic assessment	2.00	$259	$89
93503	Placement of flow directed catheter (eg, Swan-Ganz) for monitoring	1.80	$0	$132
93505	Endomyocardial biopsy	2.91	$712	$228
93530	Right heart catheterization for congenital cardiac anomalies	3.97	$0	$216
93531	Combined right & retrograde left heart cath for congenital cardiac anomalies	8.34	$0	$446
93532	Combined right & transseptal left heart cath through intact septum for congenital cardiac anomalies	9.99	$0	$556
93533	Combined right & transseptal left heart cath through intact septum for congenital cardiac anomalies	6.69	$0	$371
93561	Indicator dilution study with cardiac output (separate procedure)	0.25	$0	$13
93562	Indicator dilution study; subsequent measurement of cardiac output	0.01	$0	$1
+93563	Injection/imaging for coronary angiography with cath for congenital anomaly	1.11	$61	$61
+93564	Injection/imaging for bypass graft angiography with cath for congenital anomaly	1.13	$64	$64
+93565	Injection/imaging for left heart angiography with cath for congenital anomaly	0.86	$47	$47
+93566	Injection/imaging for right heart angiography with cath for congenital anomaly	0.86	$164	$48
+93567	Injection/imaging procedure for supravalvular aortography	0.97	$139	$55
+93568	Injection/imaging procedure for pulmonary angiography	0.88	$147	$50
+93571	Intravascular coronary flow reserve measurement, initial vessel	1.80	$0	$100
+93572	Intravascular coronary flow reserve measurement, each additional vessel	1.44	$0	$80
+92978	Coronary vessel or graft imaging with IVUS or OCT, initial vessel	1.80	$0	$100
+92979	Coronary vessel or graft imaging with IVUS or OCT, each additional vessel	1.44	$0	$80