CPT 93505Cardiology

Endomyocardial biopsy

CPT 93505 covers endomyocardial biopsy, a procedure where a physician obtains small tissue samples from the inner lining of the heart muscle, typically to diagnose conditions like heart transplant rejection, cardiomyopathy, or myocarditis.

Showing rates for

National Average

Base Medicare rate

$600.03

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

4.12

PE RVU (NF)

13.64

MP RVU

0.79

Total RVU

18.55

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

NCCI bundling edits

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Billing tips

Bill 93505 only once per session regardless of number of tissue samples obtained; the code includes multiple biopsies taken during the same procedure
Impact: Prevents automatic denials for duplicate billing; multiple units are not separately reimbursable
Do not separately bill for fluoroscopic guidance (76000, 77001, 77002) as it is included in the procedure; only echocardiographic guidance (93662) may be separately reportable
Impact: Prevents unbundling denials and recoupment of approximately $50-150 in incorrectly billed imaging codes
Document the approach (venous access site), imaging guidance used, number of samples obtained, and any complications encountered to support medical necessity
Impact: Reduces denial rate by 30-40% and strengthens appeal position if medical necessity is questioned
For transplant surveillance biopsies, ensure documentation includes time since transplant and adherence to established surveillance protocols
Impact: Prevents medical necessity denials particularly for routine surveillance beyond 1 year post-transplant
When performed with right heart catheterization (93451-93453), verify payer-specific bundling edits; some payers allow separate payment with modifier while others bundle
Impact: Proper modifier use can preserve up to $600.03 in reimbursement that would otherwise be bundled
Verify precertification requirements for non-transplant indications; many payers require prior authorization for cardiomyopathy or myocarditis workup
Impact: Obtaining precertification prevents denials that can delay payment by 60-90 days or result in complete write-offs

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 93505 in 2025?

The 2025 Medicare national average reimbursement for CPT 93505 is $600.03 for both facility and non-facility settings, based on 18.55 total RVUs and the 2025 conversion factor of 32.3465.

Can CPT 93505 be billed with a right heart catheterization on the same day?

Yes, but CPT 93505 can be bundled with right heart catheterization codes (93451-93453) by many payers. You must use modifier 59 or XU and document that the endomyocardial biopsy was a distinct, medically necessary procedure separate from the diagnostic catheterization to receive separate payment.

How many tissue samples are included in CPT code 93505?

CPT 93505 includes all endomyocardial tissue samples obtained during a single biopsy session, regardless of number. You should only bill one unit of 93505 per session even if multiple samples (typically 3-6 pieces) are taken.

What documentation is required to bill CPT 93505 for Medicare patients?

Required documentation includes clinical indication with supporting findings, venous access site, imaging guidance type, chamber(s) biopsied, number of samples obtained, complications, and preliminary findings. For transplant patients, include time since transplant and surveillance protocol adherence.

Is prior authorization required for CPT code 93505?

Prior authorization requirements vary by payer and indication. Transplant surveillance biopsies typically do not require authorization when following established protocols, but biopsies for cardiomyopathy, myocarditis, or other non-transplant indications often require precertification from commercial payers.

Can fluoroscopy guidance be billed separately with CPT 93505?

No, fluoroscopic guidance (76000, 77001, 77002) is bundled into CPT 93505 and should not be billed separately. However, intracardiac echocardiographic guidance (93662) may be separately reportable when performed and documented.

What is the difference between facility and non-facility rates for CPT 93505?

For CPT 93505, both the facility and non-facility Medicare rates are identical at $600.03 in 2025. This is unusual and reflects that the procedure is almost exclusively performed in facility settings where the facility bills separately for technical resources.