CPT 75573Radiology

Ct hrt c+ strux cgen hrt ds

CPT code 75573 covers a specialized CT scan of the heart using contrast dye to evaluate the structure of congenital heart disease (heart defects present from birth). This advanced imaging helps doctors see detailed 3D views of abnormal heart anatomy.

Showing rates for

National Average

Base Medicare rate

$301.79

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

2.55

PE RVU (NF)

6.61

MP RVU

0.17

Total RVU

9.33

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Ensure diagnosis code clearly indicates congenital heart disease (Q20-Q26 series) as 75573 is specific to congenital structural evaluation, not acquired disease
Impact: Prevents denials for medical necessity; claims without congenital diagnosis codes face 60-80% denial rate
Do not unbundle from comprehensive cardiac CT codes (75571, 75572, 75574) - verify exact scope of study performed to select correct code
Impact: Avoids downcoding and recoupment; incorrect code selection can result in $150-200 payment differential
Document 3D post-processing and reconstruction in the report as this is an integral component of 75573 reimbursement
Impact: Prevents downcoding to non-contrast or basic CT codes; maintains full $301.79 Medicare rate
Bill globally when facility owns equipment and employs interpreting physician; split with 26/TC modifiers only when components are truly separate
Impact: Maintains full 9.33 RVU payment when appropriate; improper modifier use reduces payment unnecessarily
Verify contrast administration is documented including type, amount, and route as contrast is required for 75573
Impact: Missing contrast documentation triggers automatic denials; appeals require chart amendment delaying payment 60-90 days
For pediatric patients, ensure age-appropriate protocols and radiation dose documentation to satisfy quality measures and prevent audits
Impact: Reduces audit risk; facilities with poor pediatric protocols face increased scrutiny and potential payment withholding

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 75573 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 75573 is $301.79 for both facility and non-facility settings. This is based on 9.33 total RVUs (2.55 work RVU, 6.61 practice expense RVU, 0.17 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 75573 and 75574?

CPT 75573 is specifically for CT angiography to evaluate congenital heart disease structure, while 75574 is for comprehensive cardiac CT including coronary arteries, cardiac structure, and morphology. Use 75573 only when the primary indication is evaluation of congenital heart defects; 75574 is typically used for acquired disease or when both coronary and structural evaluation are performed.

Can CPT 75573 be billed with modifier 26 for professional component only?

Yes, CPT 75573 can be split using modifier 26 for the professional component (physician interpretation) and modifier TC for the technical component (equipment and technologist). This is appropriate when the interpreting physician does not own the imaging equipment, such as in hospital settings where radiologists are not employed by the facility.

What diagnosis codes support medical necessity for CPT 75573?

ICD-10 codes in the Q20-Q26 series support medical necessity for CPT 75573, including Q20.x (congenital malformations of cardiac chambers), Q21.x (septal defects), Q22.x (pulmonary and tricuspid valve anomalies), Q23.x (aortic and mitral valve anomalies), Q24.x (other congenital cardiac malformations), Q25.x (congenital malformations of great arteries), and Q26.x (congenital malformations of great veins).

How many RVUs is CPT code 75573 worth in 2025?

CPT 75573 has 9.33 total RVUs in 2025, consisting of 2.55 work RVUs, 6.61 practice expense RVUs (both facility and non-facility), and 0.17 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

Can CPT 75573 and 75571 be billed together on the same date of service?

No, CPT 75573 and 75571 should not typically be billed together as they represent overlapping cardiac CT studies with different focuses. Code 75571 is for CT of the heart without contrast followed by contrast, while 75573 is specifically for congenital heart disease evaluation. Billing both together will likely result in bundling denials. Select the single code that best represents the complete service performed.

What specialties most commonly bill CPT code 75573?

CPT 75573 is most commonly billed by radiologists specializing in cardiovascular or pediatric radiology, cardiologists performing cardiac imaging, and pediatric cardiologists. The code is typically used in specialized settings including children's hospitals, academic medical centers, and advanced cardiac imaging facilities that have equipment and expertise for congenital heart disease evaluation.