CPT 75580Radiology

N-invas est c ffr sw aly cta

CPT 75580 covers the computer software analysis of CT angiography images to calculate fractional flow reserve (FFR-CT), which helps doctors determine if blockages in heart arteries are restricting blood flow without invasive catheterization.

Showing rates for

National Average

Base Medicare rate

$839.07

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

0.75

PE RVU (NF)

25.11

MP RVU

0.08

Total RVU

25.94

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

NCCI bundling edits

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Billing tips

Always bill 75580 as an add-on code with primary coronary CTA code (75574 or 75572)
Impact: Prevents automatic denial; 75580 cannot be billed alone and will result in 100% payment denial
Verify software vendor has FDA clearance and document the specific software platform used (HeartFlow, cFFR, etc.)
Impact: Required for medical necessity; lack of documentation can trigger $839.07 recoupment
Ensure separate physician interpretation and report specifically for FFR-CT analysis beyond the CTA interpretation
Impact: Separate documentation required to support $839.07 payment; bundled reports often denied
Check payer-specific coverage policies; many commercial payers do not cover FFR-CT or require prior authorization
Impact: Can prevent $839.07 denial and patient balance billing issues; coverage varies significantly by payer
Link appropriate ICD-10 codes indicating chest pain, angina, or known CAD to establish medical necessity
Impact: Improves first-pass payment rate by 30-40%; vague diagnoses increase audit risk
Bill facility and non-facility rates correctly based on place of service; both are $839.07 for 2025
Impact: Unique situation where facility and non-facility rates are identical at $839.07

Common denials

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Frequently asked questions

What is the Medicare payment rate for CPT code 75580 in 2025?

The 2025 Medicare national average payment rate for CPT 75580 is $839.07 for both facility and non-facility settings. This rate is based on 25.94 total RVUs multiplied by the 2025 conversion factor of $32.3465.

Can CPT 75580 be billed alone without another procedure code?

No, CPT 75580 is an add-on code and must be billed with a primary coronary CTA code such as 75574 (CTA heart with contrast and quantitative evaluation) or 75572. Billing 75580 alone will result in automatic denial.

What is the difference between FFR-CT (75580) and invasive FFR?

FFR-CT (75580) is a non-invasive computational analysis of CT angiography images to estimate fractional flow reserve, while invasive FFR requires cardiac catheterization with pressure wire measurements. CPT 75580 covers only the non-invasive software analysis of existing CTA data.

Do all insurance companies cover CPT code 75580?

No, coverage for CPT 75580 varies significantly by payer. Medicare covers FFR-CT in specific circumstances, but many commercial payers consider it experimental or require prior authorization. Always verify coverage before performing the service to avoid patient balance billing.

What RVU values are assigned to CPT 75580 for 2025?

CPT 75580 has 2025 RVU values of 0.75 work RVU, 25.11 practice expense RVU (both facility and non-facility), and 0.08 malpractice RVU, totaling 25.94 RVUs.

What documentation is required to bill CPT 75580?

Required documentation includes a separate physician interpretation report specifically addressing the FFR-CT analysis (distinct from the base CTA report), identification of the software platform used, FFR values for each major vessel, clinical indication for functional assessment, and confirmation of adequate image quality for computational analysis.

How often is CPT 75580 denied and what are common reasons?

Common denial reasons for CPT 75580 include billing without the primary CTA code, lack of separate FFR-CT interpretation documentation, medical necessity issues, coverage exclusions for experimental technology, and inadequate documentation of the specific software platform used for analysis.