Coronary art/grft angio s&i
CPT code 93455 covers the physician's work of supervising and interpreting coronary angiography imaging—X-ray pictures of the heart's arteries and any bypass grafts to check for blockages or narrowing.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Always verify whether reporting global code or professional component only with modifier 26—hospital-based physicians typically bill 26 modifier while facility bills technical component
Impact: Incorrect modifier use causes 100% denials or significant overpayment recovery risk; 26 modifier reduces payment to approximately 20-30% of global rate
Document all vessels visualized including specific bypass grafts (LIMA, RIMA, SVG) and native coronary anatomy—specify which grafts are patent, stenotic, or occluded
Impact: Inadequate documentation of graft imaging may result in downcoding to 93454 (native vessels only), reducing payment by approximately $150-200
Report 93455 only once per session regardless of number of grafts or native vessels imaged—this is an all-inclusive S&I code for coronary and graft angiography
Impact: Billing 93455 multiple times per session results in bundling denials and potential audit flags for upcoding
Ensure separate documentation for S&I from the catheterization procedure note—interpretation should include detailed findings, measurements, and clinical correlation
Impact: Missing or inadequate S&I documentation is primary audit trigger; can result in full recoupment of the $933.20 payment plus potential penalties
Bill 93455 with appropriate catheterization placement codes (93458, 93459, 93460, 93461) based on which chambers were accessed and imaged during the same session
Impact: Unbundling S&I from catheterization placement by billing only 93455 without placement code typically results in denial; combined coding yields $2,000-3,500 total reimbursement
For Medicare patients, verify LCD and NCD coverage requirements including medical necessity indicators before scheduling—prior MI, abnormal stress test, chest pain with high-risk features
Impact: Lack of documented medical necessity is the leading cause of denials; average appeal costs $200-500 per case versus preventing denial upfront
Common denials
Missing or invalid modifier 26 when billing professional component only in facility setting
How to appeal: Resubmit claim with corrected modifier 26 attached to 93455. Include attestation that physician performed only S&I component and facility billed technical separately. Provide split billing agreement if available.
Insufficient documentation of bypass graft visualization—documentation only describes native vessels leading to downcoding to 93454
How to appeal: Submit complete procedural report and interpretation showing specific documentation of bypass graft imaging (which grafts, stenosis assessment, flow characteristics). Highlight graft-specific findings in cover letter. Request review for correct code 93455.
Medical necessity denial due to lack of supporting diagnosis or indication for coronary angiography with graft assessment
How to appeal: Provide comprehensive clinical documentation including history of CABG, current symptoms, preceding diagnostic tests (stress test, CTA), and clinical decision-making justification. Reference applicable LCD/NCD coverage criteria. Include supporting office notes and test results.
Bundling denial when billed with intervention codes or other catheterization services due to NCCI edits
How to appeal: If services were truly distinct and separate, resubmit with appropriate modifier (59 or XU) and detailed explanation of why diagnostic angiography was medically necessary separate from intervention. Note that diagnostic angiography prior to planned intervention may not be separately payable unless clinical circumstances changed.
Frequently asked questions
What is the Medicare reimbursement rate for CPT code 93455 in 2025?
The 2025 Medicare national average payment for CPT 93455 is $933.20 for both facility and non-facility settings. This represents the global service; when billing with modifier 26 (professional component only), reimbursement is reduced to approximately 25-30% of the global rate, typically around $230-280 depending on locality adjustments.
What is the difference between CPT 93454 and 93455?
CPT 93454 covers coronary angiography supervision and interpretation for native coronary vessels only, while CPT 93455 includes imaging of both native coronary arteries AND arterial or venous bypass grafts. Code 93455 should only be used for patients with previous CABG surgery where grafts are visualized during the procedure.
Can CPT 93455 be billed with modifier 26?
Yes, modifier 26 is commonly appended to 93455 when the physician performs only the professional component (supervision and interpretation) while the facility bills the technical component separately. This is standard practice in hospital-based catheterization laboratories where the facility owns the equipment and employs the technical staff.
How many RVUs is CPT code 93455 worth in 2025?
CPT 93455 has 28.85 total RVUs in 2025, consisting of 5.29 work RVUs, 22.52 practice expense RVUs (both facility and non-facility), and 1.04 malpractice RVUs. This relatively high RVU value reflects the complexity and risk of coronary angiography supervision and interpretation.
What documentation is required to bill CPT 93455?
Documentation must include the indication for the procedure, description of all native coronary vessels visualized with stenosis quantification, specific identification of each bypass graft imaged (type, target vessel, patency status), quality assessment, clinical interpretation, and physician signature. The report must clearly demonstrate that both native vessels AND grafts were visualized to justify 93455 over 93454.
Can CPT 93455 be billed more than once per day?
CPT 93455 should generally only be reported once per catheterization session, as it is an all-inclusive code covering supervision and interpretation of all coronary and graft imaging performed during that session. Repeat procedures on the same day would require modifier 76 or 77 with strong medical necessity documentation and often receive reduced reimbursement.
What are common denial reasons for CPT 93455?
Common denials include missing or incorrect modifier 26 in facility settings, insufficient documentation of bypass graft visualization leading to downcoding to 93454, lack of medical necessity documentation, and bundling issues when billed with intervention codes. Proper documentation of graft-specific findings and appropriate modifier use prevents most denials.