Procedure code and description
93458 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary
angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed $321 5.85
93452 Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed 07/01/2013 Diagnostic Cardiac Heart Catheterizations
93453 Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed 07/01/2013 Diagnostic Cardiac Heart Catheterizations
93454 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) forcoronary angiography, imaging supervision and interpretation 07/01/2013 Diagnostic Cardiac Heart Catheterizations
93455 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypassgraft(s) (internal mammary, free arterial venous grafts) including intraprocedural injection(s) for bypass graft angiography 07/01/2013 Diagnostic Cardiac Heart Catheterizations
93456Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization 07/01/2013 Diagnostic Cardiac Heart Catheterizations
93457 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization 07/01/2013 Diagnostic Cardiac Heart Catheterizations
93458 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) forcoronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed 07/01/2013 Diagnostic Cardiac Heart Catheterizations
93459 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography 07/01/2013 Diagnostic Cardiac Heart Catheterizations
93460 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed 07/01/2013 Diagnostic Cardiac Heart Catheterizations
93461 Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography 07/01/2013 Diagnostic Cardiac Heart Catheterizations
93462 Left heart catheterization by transseptal puncture through intact septum or by transapical puncture. Note: Add on code will not require separate precertification in addition to primary procedure 07/01/2013 Diagnostic Cardiac Heart Catheterizations
93303 Transthoracic echocardiography for congenital cardiac anomalies 04/01/2014 Echocardiogram
Diagnostic Catheterization
• Diagnostic left heart catheterization (ventriculography only): procedure code 93452
• Combined right and left heart catheterization (ventriculography only): procedurecode 93453
• Coronary Arteriogram (no ventriculography): procedure codes 93454, 93455
• Coronary Arteriogram and right catheterization (no ventriculography): procedurecodes 93456, 93457
• Coronary Arteriogram (with ventriculography): procedure codes 93458, 93459
• Coronary Arteriogram and right catheterization (with ventriculography): procedurecodes 93460, 93461
Diagnostic cardiac catheterization is the introduction and maneuvering of a catheter into the heart to assess cardiac function. This assessment may include the measurement of intracavitary pressures, obtaining blood samples for blood gas analysis, dilution curves and determination of cardiac output. Additionally, specific angiographic information may be obtained by selective injection of contrast material.
Cardiac catheterization is generally indicated to determine the optimal therapeutic strategy in a given patient with heart disease. It may also be used to establish that the diagnosis is coronary artery disease. In most cases, the results of diagnostic cardiac catheterization would guide the physician in selecting a primarily medical vs. an interventional or surgical approach.
Cardiac catheterization may be utilized in various clinical situations ranging from those requiring only a right heart catheterization to those requiring the performance of right and left heart catheterization with simultaneous interventional procedures. The following guidelines outline the medical necessity for coverage.
Right Heart Catheterization
This is the introduction of a catheter(s) into the right atrium, right ventricle and pulmonary artery. Hemodynamic measurements, cardiac output determination, shunt determinations, blood sampling and hydrogen arrival time are commonly included as part of the procedure. Placement of catheter(s), repositioning and replacement with other catheters are included as part of the procedure. Cannulation of the coronary sinus is included in this procedure.
Indications for Right Heart Catheterization
Indications for Right Heart Catheterization
- Right heart catheterization is indicated to evaluate:
- Valvular heart disease.
- Congestive heart failure.
- Congenital heart disease.
- Cor pulmonale.
- Pulmonary hypertension.
- Intracardiac shunts.
- Endocarditis and Myocarditis.
- Cardiogenic shock.
- Myocardial infarction.
- Transplanted heart or valve.
Limitations for Right Heart Catheterization
This procedure is done in a cardiac catheterization laboratory or interventional radiology laboratory and does not include a “bedside placement” of a flow directed (Swan-Ganz type) catheter.
This procedure is done in a cardiac catheterization laboratory or interventional radiology laboratory and does not include a “bedside placement” of a flow directed (Swan-Ganz type) catheter.
- Right heart catheterization is not indicated for:
- Atherosclerotic heart disease without heart failure.
- Angioplasty or other interventional procedures.
There is no additional reimbursement for a right heart catheterization done for reasons other than hemodynamic evaluation. Studies done in conjunction with electrophysiologic tests, HIS bundle studies, pacing studies, temporary pacemaker insertion and endomyocardial biopsy are not separately payable. Right heart catheterization with hemodynamic measurements done at the same time as these above-mentioned procedures will still have to meet the requirements of medical necessity.
Left Heart Catheterization
Indications and Limitations for Left Heart Catheterization
This is the introduction of catheter(s) into the aorta, left ventricle and left atrium and includes cannulation of the coronary arteries and bypass grafts. It includes hemodynamic measurements, blood sampling and shunt determinations as part of the procedure. Placement of multiple catheters and their repositioning or replacement is included in this procedure. Injection procedures for selective opacification of arteries and conduits are separately reimbursable.
There is no additional reimbursement for a left heart catheterization done for reasons other than hemodynamic evaluation or angiography. Therefore, left heart catheterization is not separately reimbursed with studies such as electrophysiologic or pacing studies or endomyocardial biopsies (unless there is medical necessity).
Angiography
Indications and Limitations for Angiography:
Angiograms of the individual cardiac chambers will be reimbursed based on medical necessity.
Left Heart Catheterization
Indications and Limitations for Left Heart Catheterization
This is the introduction of catheter(s) into the aorta, left ventricle and left atrium and includes cannulation of the coronary arteries and bypass grafts. It includes hemodynamic measurements, blood sampling and shunt determinations as part of the procedure. Placement of multiple catheters and their repositioning or replacement is included in this procedure. Injection procedures for selective opacification of arteries and conduits are separately reimbursable.
There is no additional reimbursement for a left heart catheterization done for reasons other than hemodynamic evaluation or angiography. Therefore, left heart catheterization is not separately reimbursed with studies such as electrophysiologic or pacing studies or endomyocardial biopsies (unless there is medical necessity).
Angiography
Indications and Limitations for Angiography:
Angiograms of the individual cardiac chambers will be reimbursed based on medical necessity.
Aortography is reimbursable only for diagnoses of aortic root disease, valvular heart disease or congenital heart disease. It is not reimbursable for atherosclerotic heart disease. Angiograms to visualize the coronary ostia are included as part of coronary angiography. A diagnosis of “rule out (valvular lesion)” is not reimbursable.
Coronary angiography includes arteriograms of all the coronary arteries and their branches, regardless of the number of vessels visualized. Coronary angiography includes angiograms done with the administration of medications for diagnostic purposes (e.g., ergonovine, nitroglycerin) as part of the procedure. The selective injection procedures may be performed without a formal left heart catheterization.
Angioplasty/Stent Placement/Atherectomy
Coronary angiography includes arteriograms of all the coronary arteries and their branches, regardless of the number of vessels visualized. Coronary angiography includes angiograms done with the administration of medications for diagnostic purposes (e.g., ergonovine, nitroglycerin) as part of the procedure. The selective injection procedures may be performed without a formal left heart catheterization.
Angioplasty/Stent Placement/Atherectomy
Indications and Limitations for Angioplasty/Stent Placement/Atherectomy:
The interventional procedures: percutaneous transluminal angioplasty, coronary stent placement and atherectomy are described under the Interventional Cardiology LCD, 4C-54. These are separately reimbursable procedures. Diagnostic cardiac catheterization with coronary angiography performed prior to an interventional procedure is reimbursable whether done on the same day or on a previous day, when used as a diagnostic tool to evaluate the need for the intervention, but only once prior to the interventional procedure.
General Limitations
The completion of the diagnostic cardiac catheterization and the interventional procedure on the same day is increasingly the standard of practice. While there may be legitimate reasons for delaying the interventional procedure (e.g., transfer from a community hospital to a tertiary center), Medicare strongly discourages the separation of these procedures to circumvent the multiple surgery pricing.
Cardiac catheterization requires personal (in person) supervision of its performance by a physician. When performed in a teaching setting, the teaching physician must be present with the resident throughout the procedure. The performance by the resident alone would not establish a basis for fee schedule payment for such services.
Vascular closure of the puncture site is an inherent part of all procedures for arterial access. As such, it is included in the arterial access codes for all angiographic and catheterization procedures, and may not be billed separately. Percutaneous vascular closure devices (PVCD) are now available to close an arterial puncture site after angiography, cardiac catheterization and interventional cardiology procedures. These devices are used in place of manual compression, a mechanical clamp to apply pressure to the puncture site, a sandbag or a combination of these methods.
Several PVCDs have been approved by the FDA:
The interventional procedures: percutaneous transluminal angioplasty, coronary stent placement and atherectomy are described under the Interventional Cardiology LCD, 4C-54. These are separately reimbursable procedures. Diagnostic cardiac catheterization with coronary angiography performed prior to an interventional procedure is reimbursable whether done on the same day or on a previous day, when used as a diagnostic tool to evaluate the need for the intervention, but only once prior to the interventional procedure.
General Limitations
The completion of the diagnostic cardiac catheterization and the interventional procedure on the same day is increasingly the standard of practice. While there may be legitimate reasons for delaying the interventional procedure (e.g., transfer from a community hospital to a tertiary center), Medicare strongly discourages the separation of these procedures to circumvent the multiple surgery pricing.
Cardiac catheterization requires personal (in person) supervision of its performance by a physician. When performed in a teaching setting, the teaching physician must be present with the resident throughout the procedure. The performance by the resident alone would not establish a basis for fee schedule payment for such services.
Vascular closure of the puncture site is an inherent part of all procedures for arterial access. As such, it is included in the arterial access codes for all angiographic and catheterization procedures, and may not be billed separately. Percutaneous vascular closure devices (PVCD) are now available to close an arterial puncture site after angiography, cardiac catheterization and interventional cardiology procedures. These devices are used in place of manual compression, a mechanical clamp to apply pressure to the puncture site, a sandbag or a combination of these methods.
Several PVCDs have been approved by the FDA:
- Techstar®XL.
- Prostar®XL.
- Prostar®Plus (Perclose, Inc).
- Angio-Seal™ (Sherwood-Davis & Geck).
- VasoSeal® (Datascope Corp.).
- Any additional similar devices.
The advantages of these devices include more rapid hemostasis and earlier patient ambulation after the angiographic or cardiac procedure, allowing more of these procedures to be performed as outpatient services.
They also reduce the amount of physician time spent compressing an artery and monitoring a patient post-angiography or catheterization. These services are not separately payable with diagnostic cardiac catheterization procedures.
Other Non-covered Procedures During Catheterization:
They also reduce the amount of physician time spent compressing an artery and monitoring a patient post-angiography or catheterization. These services are not separately payable with diagnostic cardiac catheterization procedures.
Other Non-covered Procedures During Catheterization:
- Prophylactic insertion of temporary transvenous pacemaker.
- Assistant at surgery.
- Right heart catheterization for the purpose of inserting a temporary pacemaker or performing electrophysiologic studies.
- Standby anesthesia or surgeon during angioplasty.
- Repositioning and replacement of catheters.
- Administration of medications during catheterization.
- Percutaneous vascular closure (e.g., Perclose).
- Anesthesia.
Cardiac catheterization is covered for payment by Medicare when performed in the inpatient hospital, outpatient hospital, and free-standing cardiac catheterization facilities that meet the Medicare provider enrollment requirements and are enrolled with Medicare as physician directed clinics.
Payments for Cardiac Catheterization Performed in Independent Diagnostic Testing Facilities (IDTF):
Independent Diagnostic Testing Facilities are eligible for Medicare payments for cardiac catheterization services subject to this LCD. All eligible IDTFs must be accredited for performing these procedures on or before January 1, 2008. Accepted accrediting organizations are:
- Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
- Accreditation Association for Ambulatory Health Care (AAAHC).
Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:
- Safe and effective.
- Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
- Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
- Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
- Furnished in a setting appropriate to the patient’s medical needs and condition.
- Ordered and furnished by qualified personnel.
- One that meets, but does not exceed, the patient’s medical need.
- At least as beneficial as an existing and available medically appropriate alternative.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12X, 13X, 85X
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
CPT/HCPCS Codes
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Note:
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Providers are reminded to refer to the long descriptors of the CPT codes in their CPT books. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
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93451©
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Right heart catheterization – Fee schedule amount $774.29
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93452©
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Left heart catheterization – Fee schedule amount $879.09
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93453©
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Combined right and left heart catheterization
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93454©
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Catheter placement in coronary art for coronary angiography
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93455©
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Catheter placement in coronary art for coronary angiography
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93456©
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Catheter placement in coronary art for coronary angiography
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93457©
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Catheter placement in coronary art for coronary angiography
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93458©
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Catheter placement in coronary art for coronary angiography – Fee amount $1072.02
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93459©
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Catheter placement in coronary art for coronary angiography – $1184.99
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93460©
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Catheter placement in coronary art for coronary angiography Fee amount -$1272.18
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93461©
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Catheter placement in coronary art for coronary angiography – Fee amount – $1453.81
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93462©
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Left heart catheterization
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93530©
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Rt heart cath, congenital
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93531©
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R & l heart cath, congenital
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93532©
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R & l heart cath, congenital
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93533©
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R & l heart cath, congenital
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93563©
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Injection procedure during cardiac cath
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93564©
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Injection procedure during cardiac cath
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93565©
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Injection procedure during cardiac cath
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93566©
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Injection procedure during cardiac cath
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93567©
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Injection procedure during cardiac cath
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93568©
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Injection procedure during cardiac cath
Billing and Coding Guidelines What cardiac procedures will require prior authorization? A Prior authorization is required for the following procedurecodes: Diagnostic Catheterization • procedurecodes: 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461 Electrophysiology Implants • Pacemaker Implant procedurecodes: 33206, 33207, 33208, 33212, 33213, 33214, 33227, 33228 • CRT (Cardiac Resynchronization Therapy) proceduredevice codes: 33221, 33224, 33229, 33231, 33264, procedureLead 33225 • Defibrillator (AICD) Implant procedurecodes: 33230, 33240, 33249, 33262, 33263 ICD-9-CM Codes That Support Medical Necessity |
The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
DIAGNOSTIC (NONCONGENITAL) Right heart catheterization, including measurements when performed 93451 Left heart catheterization, including left ventriculography when performed 93452
Combined left and right heart catheterization, including left ventriculography when performed 93453
Coronary angiography only, without left or right heart catheterization 93454
Coronary angiography without left or right heart cath, with angiography of bypass graft(s) 93455
Coronary angiography with right heart cath 93456
Coronary angiography with angiography of bypass graft(s) and right heart cath 93457
Coronary angiography with left heart cath, including left ventriculography, when performed 93458
Coronary angiography with left heart cath with angiography of bypass graft(s) including left ventriculography when performed 93459
Coronary angiography with left and right heart cath, including left ventriculography when performed 93460
Coronary angiography with left and right heart cath, with angiography of bypass graft(s) including left
ventriculography when performed 93461
NOTES All diagnostic codes, with the exception of right heart cath 93451, are bundled to include catheter placement, injection and supervision & interpretation.
ADDITIONAL PROCEDURES
Intravascular ultrasound (coronary vessel or graft), initial vessel 92978 (+) Intravascular ultrasound (coronary vessel or graft), each additional vessel 92979 (+) Left heart catheterization by transseptal puncture 93462 (+) Pharmacologic agent administration including hemodynamic measurements* 93463 (+) Physiologic exercise study including hemodynamic measurements 93464 (+) Insertion and placement of flow-directed catheter for monitoring purposes (Swan-Ganz) 93503 Endomyocardial biopsy 93505 Indicator dilution studies including arterial and/or venous catheterization, with cardiac output measurement (separate procedure)
93561 Indicator dilution studies, subsequent measurement of cardiac output 93562 Intravascular Doppler velocity and/or pressure-derived coronary flow reserve measurement, during coronary angiography, initial vessel
93571 (+) Intravascular Doppler velocity and/or pressure-derived coronary flow reserve measurement, during coronary angiography, each additional vessel
93572 (+) Iliac and/or femoral artery angiography, nonselective, bilateral or ipsilateral to cath insertion during cardiac cath or coronary angiography G0278
NOTES *Report 93463 only once per left or right heart cath procedure. Code 93463 can be reported with transcatheter closure of septal defect but may not be reported with coronary artery interventions such as thrombolysis, angioplasty, atherectomy or stenting.
DIAGNOSTIC (CONGENITAL)
Right heart catheterization, for congenital cardiac anomalies 93530 Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies
93531 Combined right heart catheterization and transseptal left heart catheterization through intact septum with or without retrograde left heart catheterization, for congenital cardiac anomalies
93532 Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies
93533 Injection procedure, including S&I, for selective coronary angiography during CONGENITAL heart cath 93563 (+) Injection procedure, including S&I, for selective angiography of venous or arterial bypass graft(s) during CONGENITAL cath
93564 (+) Injection procedure, including S&I, for selective left ventricular or left atrial angiography during CONGENITAL heart cath
93565 (+) NOTES Anomalous coronary arteries, PFO, MVP and bicuspid aortic valve are not considered congenital cardiac anomalies for coding purposes and are assigned to the regular diagnostic codes 93451–93461.
Major Coronary Artery Modifier Branches
Left main coronary artery LM none
Left anterior descending coronary artery LD diagonal 1 diagonal 2
Left circumflex coronary artery LC obtuse marginal 1 obtuse marginal 2
Right coronary artery RC right posterior descending right posterolateral Ramus intermedius coronary artery RI none
DIAGNOSTIC (NONCONGENITAL) Right heart catheterization, including measurements when performed 93451 Left heart catheterization, including left ventriculography when performed 93452
Combined left and right heart catheterization, including left ventriculography when performed 93453
Coronary angiography only, without left or right heart catheterization 93454
Coronary angiography without left or right heart cath, with angiography of bypass graft(s) 93455
Coronary angiography with right heart cath 93456
Coronary angiography with angiography of bypass graft(s) and right heart cath 93457
Coronary angiography with left heart cath, including left ventriculography, when performed 93458
Coronary angiography with left heart cath with angiography of bypass graft(s) including left ventriculography when performed 93459
Coronary angiography with left and right heart cath, including left ventriculography when performed 93460
Coronary angiography with left and right heart cath, with angiography of bypass graft(s) including left
ventriculography when performed 93461
NOTES All diagnostic codes, with the exception of right heart cath 93451, are bundled to include catheter placement, injection and supervision & interpretation.
ADDITIONAL PROCEDURES
Intravascular ultrasound (coronary vessel or graft), initial vessel 92978 (+) Intravascular ultrasound (coronary vessel or graft), each additional vessel 92979 (+) Left heart catheterization by transseptal puncture 93462 (+) Pharmacologic agent administration including hemodynamic measurements* 93463 (+) Physiologic exercise study including hemodynamic measurements 93464 (+) Insertion and placement of flow-directed catheter for monitoring purposes (Swan-Ganz) 93503 Endomyocardial biopsy 93505 Indicator dilution studies including arterial and/or venous catheterization, with cardiac output measurement (separate procedure)
93561 Indicator dilution studies, subsequent measurement of cardiac output 93562 Intravascular Doppler velocity and/or pressure-derived coronary flow reserve measurement, during coronary angiography, initial vessel
93571 (+) Intravascular Doppler velocity and/or pressure-derived coronary flow reserve measurement, during coronary angiography, each additional vessel
93572 (+) Iliac and/or femoral artery angiography, nonselective, bilateral or ipsilateral to cath insertion during cardiac cath or coronary angiography G0278
NOTES *Report 93463 only once per left or right heart cath procedure. Code 93463 can be reported with transcatheter closure of septal defect but may not be reported with coronary artery interventions such as thrombolysis, angioplasty, atherectomy or stenting.
DIAGNOSTIC (CONGENITAL)
Right heart catheterization, for congenital cardiac anomalies 93530 Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies
93531 Combined right heart catheterization and transseptal left heart catheterization through intact septum with or without retrograde left heart catheterization, for congenital cardiac anomalies
93532 Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heart catheterization, for congenital cardiac anomalies
93533 Injection procedure, including S&I, for selective coronary angiography during CONGENITAL heart cath 93563 (+) Injection procedure, including S&I, for selective angiography of venous or arterial bypass graft(s) during CONGENITAL cath
93564 (+) Injection procedure, including S&I, for selective left ventricular or left atrial angiography during CONGENITAL heart cath
93565 (+) NOTES Anomalous coronary arteries, PFO, MVP and bicuspid aortic valve are not considered congenital cardiac anomalies for coding purposes and are assigned to the regular diagnostic codes 93451–93461.
Major Coronary Artery Modifier Branches
Left main coronary artery LM none
Left anterior descending coronary artery LD diagonal 1 diagonal 2
Left circumflex coronary artery LC obtuse marginal 1 obtuse marginal 2
Right coronary artery RC right posterior descending right posterolateral Ramus intermedius coronary artery RI none
Right Heart and Combined Right and Left Heart Catheterization
Medicare is establishing the following limited coverage for CPT/HCPCS codes 93451 and 93453:
Covered for:
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093.20–093.24
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Syphilitic endocarditis
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093.81–093.82
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Other specified cardiovascular syphilis
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093.89
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Other specified cardiovascular syphilis
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391.0–391.2
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Rheumatic fever with heart involvement
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391.8–391.9
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Rheumatic fever with heart involvement
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393
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Chronic rheumatic pericarditis
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394.0–394.2
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Diseases of mitral valve
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394.9
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Other and unspecified mitral valve diseases
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395.0–395.2
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Diseases of aortic valve
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395.9
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Other and unspecified rheumatic aortic diseases
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396.0–396.3
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Diseases of mitral and aortic valve
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396.8–396.9
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Diseases of mitral and aortic valve
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397.0–397.1
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Diseases of other endocardial structures
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397.9
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Rheumatic diseases of endocardium valve unspecified
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398.0
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Rheumatic myocarditis
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398.90–398.91
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Other rheumatic heart disease
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398.99
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Other rheumatic heart diseases
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402.01
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Malignant hypertensive heart disease with heart failure
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402.11
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Benign hypertensive heart disease with heart failure
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402.91
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Unspecified hypertensive heart disease with heart failure
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404.01
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Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage i through stage iv, or unspecified
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404.03
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Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage v or end stage renal disease
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404.11
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Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage i through stage iv, or unspecified
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404.13
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Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage v or end stage renal disease
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404.91
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Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage i through stage iv, or unspecified
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404.93
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Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage v or end stage renal disease
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410.00–410.02
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Acute myocardial infarction of anterolateral wall
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410.10–410.12
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Acute myocardial infarction of other anterior wall
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410.20–410.22
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Acute myocardial infarction of inferolateral wall
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410.30–410.32
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Acute myocardial infarction of inferoposterior wall
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410.40–410.42
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Acute myocardial infarction of other inferior wall
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410.50–410.52
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Acute myocardial infarction of other lateral wall
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410.60–410.62
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True posterior wall infarction
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410.70–410.72
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Subendocardial infarction
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410.80–410.82
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Acute myocardial infarction of other specified sites
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410.90–410.92
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Acute myocardial infarction of unspecified site
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415.0
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Acute cor pulmonale
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415.11
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Iatrogenic pulmonary embolism and infarction
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415.19
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Other pulmonary embolism and infarction
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416.0–416.2
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Chronic pulmonary heart disease
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416.8–416.9
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Chronic pulmonary heart disease
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417.0–417.1
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Other diseases of pulmonary circulation
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417.8–417.9
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Other diseases of pulmonary circulation
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420.0
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Acute pericarditis in diseases classified elsewhere
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420.90–420.91
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Other and unspecified acute pericarditis
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420.99
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Other acute pericarditis
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421.0–421.1
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Acute and subacute endocarditis
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421.9
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Acute endocarditis unspecified
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422.0
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Acute myocarditis in diseases classified elsewhere
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422.90–422.93
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Other and unspecified acute myocarditis
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422.99
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Other acute myocarditis
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423.0–423.2
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Other diseases of pericardium
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423.8–423.9
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Other diseases of pericardium
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424.0–424.3
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Other diseases of endocardium
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424.90–424.91
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Endocarditis valve unspecified
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424.99
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Other endocarditis valve unspecified
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425.0–425.5
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Cardiomyopathy
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425.7–425.9
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Cardiomyopathy
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427.1–427.2
|
Cardiac dysrhythmias
|
|
427.41–427.42
|
Ventricular fibrillation and flutter
|
|
427.5
|
Cardiac arrest
|
|
428.0–428.1
|
Heart failure
|
|
428.20–428.23
|
Systolic heart failure
|
|
428.30–428.33
|
Diastolic heart failure
|
|
428.40–428.43
|
Combined systolic and diastolic heart failure
|
|
428.9
|
Heart failure unspecified
|
|
429.0–429.6
|
Ill-defined descriptions and complications of heart disease
|
|
429.71
|
Certain sequelae of myocardial infarction not elsewhere classified acquired cardiac septal defect
|
|
429.81
|
Other disorders of papillary muscle
|
|
429.83
|
Takotsubo syndrome
|
|
745.0
|
Common truncus
|
|
745.10–745.12
|
Transposition of great vessels
|
|
745.19
|
Other transposition of great vessels
|
|
745.2–745.5
|
Bulbus cordis anomalies and anomalies of cardiac septal closure
|
|
745.60–745.61
|
Endocardial cushion defects
|
|
745.69
|
Other endocardial cushion defects
|
|
745.7–745.9
|
Bulbus cordis anomalies and anomalies of cardiac septal closure
|
|
746.00–746.02
|
Anomalies of pulmonary valve
|
|
746.09
|
Other anomalies of pulmonary valve
|
|
747.0
|
Patent ductus arteriosus
|
|
747.10–747.11
|
Coarctation of aorta
|
|
747.20–747.22
|
Other anomalies of aorta
|
|
747.29
|
Other anomalies of aorta
|
|
747.3
|
Anomalies of pulmonary artery
|
|
747.40–747.42
|
Anomalies of great veins
|
|
747.49
|
Other anomalies of great veins
|
|
785.51
|
Cardiogenic shock
|
|
794.30–794.31
|
Cardiovascular, nonspecific abnormal results of cardiovascular function studies
|
|
794.39
|
Other nonspecific abnormal results of function studies
|
|
996.02
|
Mechanical complication of heart valve prosthesis
|
|
996.74
|
Other complications due to other vascular device implant and graft
|
|
996.83
|
Complications of transplanted heart
|
|
V12.51
|
Personal history of venous thrombosis and embolism
|
|
V42.1
|
Heart replaced by transplant
|
|
V42.2
|
Heart valve replaced by transplant
|
|
V42.6
|
Lung replaced by transplant
|
|
V43.3
|
Heart valve replaced by other means
|
|
V58.44
|
Aftercare following organ transplant
|
Left Heart Catheterization
Medicare is establishing the following limited coverage for CPT/HCPCS codes 93452 and 93462:
Covered for:
|
394.0–394.2
|
Diseases of mitral valve
|
|
394.9
|
Other and unspecified mitral valve diseases
|
|
395.0–395.2
|
Diseases of aortic valve
|
|
395.9
|
Other and unspecified rheumatic aortic diseases
|
|
396.0–396.3
|
Diseases of mitral and aortic valve
|
|
396.8–396.9
|
Diseases of mitral and aortic valve
|
|
397.0–397.1
|
Diseases of other endocardial structures
|
|
397.9
|
Rheumatic diseases of endocardium valve unspecified
|
|
402.00–402.01
|
Malignant hypertensive heart disease
|
|
402.10–402.11
|
Benign hypertensive heart disease
|
|
402.90–402.91
|
Unspecified hypertensive heart disease
|
|
410.00–410.02
|
Acute myocardial infarction of anterolateral wall
|
|
410.10–410.12
|
Acute myocardial infarction of other anterior wall
|
|
410.20–410.22
|
Acute myocardial infarction of inferolateral wall
|
|
410.30–410.32
|
Acute myocardial infarction of inferoposterior wall
|
|
410.40–410.42
|
Acute myocardial infarction of other inferior wall
|
|
410.50–410.52
|
Acute myocardial infarction of other lateral wall
|
|
410.60–410.62
|
True posterior wall infarction
|
|
410.70–410.72
|
Subendocardial infarction
|
|
410.80–410.82
|
Acute myocardial infarction of other specified sites
|
|
410.90–410.92
|
Acute myocardial infarction of unspecified site
|
|
411.0–411.1
|
Other acute and subacute forms of ischemic heart disease
|
|
411.81
|
Acute coronary occlusion without myocardial infarction
|
|
411.89
|
Other acute and subacute forms of ischemic heart disease other
|
|
412
|
Old myocardial infarction
|
|
413.0–413.1
|
Angina pectoris
|
|
413.9
|
Other and unspecified angina pectoris
|
|
414.00–414.06
|
Coronary atherosclerosis
|
|
414.07
|
Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart
|
|
414.10–414.11
|
Aneurysm and dissection of heart
|
|
414.19
|
Other aneurysm of heart
|
|
414.3
|
Coronary atherosclerosis due to lipid rich plaque
|
|
414.8–414.9
|
Other specified forms of chronic ischemic heart disease
|
|
420.0
|
Acute pericarditis in diseases classified elsewhere
|
|
420.90–420.91
|
Other and unspecified acute pericarditis
|
|
420.99
|
Other acute pericarditis
|
|
421.0–421.1
|
Acute and subacute endocarditis
|
|
421.9
|
Acute endocarditis unspecified
|
|
422.0
|
Acute myocarditis in diseases classified elsewhere
|
|
422.90–422.93
|
Other and unspecified acute myocarditis
|
|
422.99
|
Other acute myocarditis
|
|
423.0–423.2
|
Other diseases of pericardium
|
|
423.8–423.9
|
Other diseases of pericardium
|
|
424.0–424.3
|
Other diseases of endocardium
|
|
424.90–424.91
|
Endocarditis valve unspecified
|
|
424.99
|
Other endocarditis valve unspecified
|
|
425.0–425.5
|
Cardiomyopathy
|
|
425.7–425.9
|
Cardiomyopathy
|
|
426.7
|
Anomalous atrioventricular
|
|
427.0
|
Paroxysmal supraventricular
|
|
427.1–427.2
|
Cardiac dysrhythmias
|
|
427.31–427.32
|
Atrial fibrillation and flutter
|
|
427.41–427.42
|
Ventricular fibrillation and flutter
|
|
427.5
|
Cardiac arrest
|
|
427.89
|
Other specified cardiac dysrhythmias
|
|
428.0–428.1
|
Heart failure
|
|
428.20–428.23
|
Systolic heart failure
|
|
428.30–428.33
|
Diastolic heart failure
|
|
428.40–428.43
|
Combined systolic and diastolic heart failure
|
|
429.0–429.6
|
Ill-defined descriptions and complications of heart disease
|
|
429.71
|
Certain sequelae of myocardial infarction not elsewhere classified acquired cardiac septal defect
|
|
429.79
|
Certain sequelae of myocardial infarction not elsewhere classified other
|
|
429.81–429.83
|
Other ill-defined heart diseases
|
|
429.89
|
Other ill-defined heart diseases
|
|
786.05
|
Shortness of breath
|
|
786.09
|
Respiratory abnormality other
|
|
786.50–786.52
|
Chest pain
|
|
786.59
|
Other chest pain
|
|
793.2
|
Nonspecific (abnormal) findings on radiological and other examination of other intrathoracic organs
|
|
794.30–794.31
|
Cardiovascular, nonspecific abnormal results of function tests
|
|
794.39
|
Other nonspecific abnormal results of cardiovascular function tests
|
|
996.02–996.03
|
Mechanical complication of cardiac device implant and graft
|
|
996.09
|
Other mechanical complication of cardiac device implant and graft
|
|
996.61–996.62
|
Infection and inflammatory reaction due to internal prosthetic device implant and graft
|
|
996.71–996.72
|
Other complications of internal (biological) (synthetic) prosthetic device implant and graft
|
|
996.83
|
Complications of transplanted heart
|
|
997.1
|
Cardiac complications not elsewhere classified
|
|
V12.53
|
Personal history of sudden cardiac arrest icd9 update
|
|
V42.1
|
Heart replaced by transplant
|
|
V42.2
|
Heart valve replaced by transplant
|
|
V45.81
|
Postsurgical aortocoronary bypass status
|
|
V45.82
|
Percutaneous transluminal coronary angioplasty status
|
Coronary Arteriograms
Medicare is establishing the following limited coverage for CPT/HCPCS codes 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93565, 93566 and 93567:
Covered for:
|
394.0–394.2
|
Diseases of mitral valve
|
|
394.9
|
Other and unspecified mitral valve diseases
|
|
395.0–395.2
|
Diseases of aortic valve
|
|
395.9
|
Other and unspecified rheumatic aortic diseases
|
|
396.0–396.3
|
Diseases of mitral and aortic valve
|
|
396.8–396.9
|
Diseases of mitral and aortic valve
|
|
402.00–402.01
|
Malignant hypertensive heart disease
|
|
402.10–402.11
|
Benign hypertensive heart disease
|
|
402.90–402.91
|
Unspecified hypertensive heart disease
|
|
410.00–410.02
|
Acute myocardial infarction of anterolateral wall
|
|
410.10–410.12
|
Acute myocardial infarction of other anterior wall
|
|
410.20–410.22
|
Acute myocardial infarction of inferolateral wall
|
|
410.30–410.32
|
Acute myocardial infarction of inferoposterior wall
|
|
410.40–410.42
|
Acute myocardial infarction of other inferior wall
|
|
410.50–410.52
|
Acute myocardial infarction of other lateral wall
|
|
410.60–410.62
|
True posterior wall infarction
|
|
410.70–410.72
|
Subendocardial infarction
|
|
410.80–410.82
|
Acute myocardial infarction of other specified sites
|
|
410.90–410.92
|
Acute myocardial infarction of unspecified site
|
|
411.0–411.1
|
Other acute and subacute forms of ischemic heart disease
|
|
411.81
|
Acute coronary occlusion without myocardial infarction
|
|
411.89
|
Other acute and subacute forms of ischemic heart disease other
|
|
412
|
Old myocardial infarction
|
|
413.0–413.1
|
Angina pectoris
|
|
413.9
|
Other and unspecified angina pectoris
|
|
414.00–414.06
|
Coronary atherosclerosis
|
|
414.07
|
Coronary atherosclerosis of bypass graft (artery) (vein) of transplanted heart
|
|
414.10
|
Aneurysm of heart (wall)
|
|
414.3
|
Coronary atherosclerosis due to lipid rich plaque
|
|
414.8–414.9
|
Other specified forms of chronic ischemic heart disease
|
|
420.0
|
Acute pericarditis in diseases classified elsewhere
|
|
420.90–420.91
|
Other and unspecified acute pericarditis
|
|
420.99
|
Other acute pericarditis
|
|
424.0–424.2
|
Other diseases of endocardium
|
|
425.0–425.5
|
Cardiomyopathy
|
|
425.7–425.9
|
Cardiomyopathy
|
|
427.1–427.2
|
Cardiac dysrhythmias
|
|
427.31–427.32
|
Atrial fibrillation and flutter
|
|
427.41–427.42
|
Ventricular fibrillation and flutter
|
|
427.5
|
Cardiac arrest
|
|
427.89
|
Other specified cardiac dysrhythmias
|
|
428.0–428.1
|
Heart failure
|
|
428.20–428.23
|
Systolic heart failure
|
|
428.30–428.33
|
Diastolic heart failure
|
|
428.40–428.43
|
Combined systolic and diastolic heart failure
|
|
428.9
|
Heart failure unspecified
|
|
429.0–429.6
|
Ill-defined descriptions and complications of heart disease
|
|
429.71
|
Certain sequelae of myocardial infarction not elsewhere classified acquired cardiac septal defect
|
|
429.79
|
Certain sequelae of myocardial infarction not elsewhere classified other
|
|
429.83
|
Takotsubo syndrome
|
|
441.2
|
Thoracic aneurysm without rupture
|
|
674.50–674.54
|
Peripartum cardiomyopathy
|
|
745.0
|
Common truncus
|
|
745.10–745.12
|
Transposition of great vessels
|
|
745.19
|
Other transposition of great vessels
|
|
745.2–745.5
|
Bulbus cordis anomalies and anomalies of cardiac septal closure
|
|
745.60–745.61
|
Endocardial cushion defects
|
|
745.69
|
Other endocardial cushion defects
|
|
745.7–745.9
|
Bulbus cordis anomalies and anomalies of cardiac septal closure
|
|
746.85
|
Coronary artery anomaly congenital
|
|
786.02
|
Orthopnea
|
|
786.05
|
Shortness of breath
|
|
786.50–786.52
|
Chest pain
|
|
786.59
|
Other chest pain
|
|
793.2
|
Nonspecific (abnormal) findings on radiological and other examination of other intrathoracic organs
|
|
794.30–794.31
|
Cardiovascular, non-specific abnormal results of function tests
|
|
794.39
|
Other, non-specific abnormal results of cardiovascular function tests
|
|
861.01
|
Contusion of heart without open wound into thorax
|
|
996.02–996.03
|
Mechanical complication of cardiac device implant and graft
|
|
996.09
|
Other mechanical complication of cardiac device implant and graft
|
|
996.61–996.62
|
Infection and inflammatory reaction due to internal prosthetic device implant and graft
|
|
996.71–996.72
|
Other complications of internal (biological) (synthetic) prosthetic device implant and graft
|
|
996.83
|
Complications of transplanted heart
|
|
997.1
|
Cardiac complications not elsewhere classified
|
|
V12.53
|
Personal history of sudden cardiac arrest
|
|
V42.1
|
Heart replaced by transplant
|
|
V42.2
|
Heart valve replaced by transplant
|
|
V43.21
|
Heart replaced by heart assist device
|
|
V43.22
|
Heart replaced by fully implantable artificial heart
|
|
V58.44
|
Aftercare following organ transplant
|
|
V58.69
|
Long-term (current) use of other medications
|
|
V81.0*
|
Screening for ischemic heart disease
|
|
Note: *Code V81.0 for angiography to assess ischemic heart disease without a prior cardiac stress test along with an appropriate diagnosis of angina.
|
Cardiac Catheterization for Congenital Cardiac Anomalies
Medicare is establishing the following limited coverage for CPT/HCPCS codes 93530, 93531, 93532, 93533, 93563, 93564, 93565 and 93566:
Covered for:
|
745.0
|
Common truncus
|
|
745.10–745.12
|
Transposition of great vessels
|
|
745.19
|
Other transposition of great vessels
|
|
745.2–745.5
|
Bulbus cordis anomalies and anomalies of cardiac septal closure
|
|
745.60–745.61
|
Endocardial cushion defects
|
|
745.69
|
Other endocardial cushion defects
|
|
745.7–745.9
|
Bulbus cordis anomalies and anomalies of cardiac septal closure
|
|
746.00–746.02
|
Anomalies of pulmonary valve
|
|
746.09
|
Other congenital anomalies of pulmonary valve
|
|
746.1–746.7
|
Other congenital anomalies of heart
|
|
746.81–746.89
|
Other specified anomalies of heart
|
|
746.9
|
Unspecified anomaly of heart
|
|
747.0
|
Patent ductus arteriosus
|
|
747.10–747.11
|
Coarctation of aorta
|
|
747.20–747.22
|
Other anomalies of aorta
|
|
747.29
|
Other congenital anomalies of aorta
|
|
747.3
|
Congenital anomalies of pulmonary artery
|
|
747.40–747.42
|
Anomalies of great veins unspecified
|
|
747.49
|
Other anomalies of great veins
|
|
794.30–794.31
|
Cardiovascular, nonspecific abnormal results of function tests
|
|
794.39
|
Other, nonspecific abnormal results of cardiovascular function tests
|
Pulmonary Angiography
Medicare is establishing the following limited coverage for CPT/HCPCS code 93568:
Covered for:
|
415.0
|
Acute cor pulmonale
|
|
415.11
|
Iatrogenic pulmonary embolism and infarction
|
|
415.19
|
Other pulmonary embolism and infarction
|
|
416.0
|
Primary pulmonary hypertension
|
|
416.2
|
Chronic pulmonary embolism
|
|
416.8
|
Other chronic pulmonary heart diseases
|
|
424.2–424.3
|
Other diseases of endocardium
|
|
429.1–429.2
|
Ill-defined descriptions and complications of heart disease
|
|
518.81–518.82
|
Other diseases of lung
|
|
518.84
|
Acute and chronic respiratory failure
|
|
639.6
|
Embolism following abortion or ectopic and molar pregnancies
|
|
745.5
|
Ostium secundum type atrial septal defect
|
|
746.00–746.02
|
Anomalies of pulmonary valve
|
|
746.09
|
Other congenital anomalies of pulmonary valve
|
|
786.00–786.01
|
Dyspnea and respiratory abnormalities
|
|
786.05–786.06
|
Dyspnea and respiratory abnormalities
|
|
786.09
|
Respiratory abnormality other
|
|
V42.1
|
Heart replaced by transplant
|
|
V42.6
|
Lung replaced by transplant
|
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.
Diagnoses That Support Medical Necessity
N/A
ICD-9-CM Codes That DO NOT Support Medical Necessity
N/A
Diagnoses That DO NOT Support Medical Necessity
All diagnoses not listed in the “ICD-9-CM Codes That Support Medical Necessity” section of this LCD.
Documentation Requirements
- Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.
- Medicare will expect that the patient’s medical record will document the patient’s clinical history and physical findings as well as relevant information regarding the course of the patient’s symptoms and findings, treatment and previous diagnostic evaluation to substantiate the medical necessity of each cardiac catheterization service billed.
- Documentation of cardiac catheterization and angiography services must be contained in a formal report of the procedure that describes in detail each service billed.
- Presence of a covered indication for right heart catheterization must be clearly documented in the medical record when right heart catheterization is billed.
- Documentation must support all information submitted with the claim such as HCPCS and ICD-9-CM codes.
- Indications for billing right or left heart catheterization at the same time of endomyocardial biopsy (CPT code 93505) must be clearly documented in the patient’s record.
- Indications for right heart angiography when performed with right heart catheterization must be clearly documented in the patient’s record.
- Indications for aortic root aortography when performed with cardiac heart catheterization must be clearly documented in the patient’s record.
- The medical record must clearly demonstrate that angiography and/or intervention of extra-cardiac vessels were medically reasonable and necessary for the diagnosis and treatment of disease in accordance with accepted authoritative practice standards.
