Njx cgen car cath slctv opac
CPT code 93564 covers the injection of contrast dye into specific coronary arteries or bypass grafts during a cardiac catheterization procedure to create detailed X-ray images of the heart's blood vessels.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Report 93564 per selective injection, not per catheterization session. Multiple injections into different vessels require multiple units.
Impact: Proper unit reporting can increase reimbursement by $52.40 per additional selective injection site when medically necessary and documented
Verify NCCI edits before billing with primary catheterization codes (93454-93461). 93564 may be bundled into some comprehensive cardiac cath codes.
Impact: Prevents automatic denials and reduces claim rework; understanding bundling rules prevents revenue loss on inappropriately unbundled services
Document each selective injection separately with specific vessel or graft identification, anatomic location, and clinical indication.
Impact: Detailed documentation supports medical necessity and multiple unit claims, reducing audit risk and denial rates by 30-40%
Bill 93564 only when performed in addition to the base catheterization procedure; it is an add-on code and cannot be billed alone.
Impact: Ensures compliance with CPT guidelines; standalone billing results in 100% claim denial
For bypass graft injections, ensure documentation specifies whether injection is into arterial or venous grafts and which specific graft.
Impact: Specific documentation supports medical necessity and prevents downcoding or denials based on insufficient documentation
Verify patient has active Part B coverage and procedure is performed in Medicare-approved facility for cardiac catheterization.
Impact: Prevents non-covered service denials; ensures $52.40 reimbursement per injection is collectible from Medicare
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