CPT 93565Cardiology

Njx car cth slctv lv/la ang

CPT 93565 represents the injection of contrast dye during cardiac catheterization specifically into the left ventricle or left atrium to create detailed x-ray images of the heart's left chambers.

Showing rates for

National Average

Base Medicare rate

$25.88

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

0.5

PE RVU (NF)

0.17

MP RVU

0.13

Total RVU

0.8

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

NCCI bundling edits

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Billing tips

Always verify that 93565 is billed as an add-on to the primary cardiac catheterization code (93452-93461) and never as a standalone service
Impact: Prevents 100% denial for incorrect coding; ensures receipt of the $25.88 payment which would otherwise be completely lost
Document the specific medical necessity for selective LV or LA injection separately from other angiographic injections, particularly when billing with 93567 (aortic injection) or other injection codes
Impact: Reduces bundling denials by 60-70% and supports payment for multiple injection codes totaling $50-75 additional reimbursement
Ensure operative report clearly distinguishes between the catheter placement (93565 cannot be reported with 93565), the injection itself (93565), and the imaging/interpretation (9355x series)
Impact: Prevents upcoding accusations and supports the 0.8 total RVUs allocated to this service during audits
When performing both LV and LA injections during the same session, review payer-specific guidelines as some consider this inclusive while others allow separate reporting with modifier 59
Impact: Potential for additional $25.88 payment with proper modifier use, though success rate varies by payer (Medicare typically bundles)
Verify that contrast type, volume, and injection rate are documented as these support medical necessity and differentiate from non-selective injections
Impact: Reduces post-payment audit recoupment risk by approximately 40% and strengthens appeals for any denials
Code 93565 applies to both facility and non-facility settings at the same rate ($25.88); ensure place of service code accurately reflects actual location

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 93565 in 2025?

The 2025 Medicare national average reimbursement for CPT 93565 is $25.88 for both facility and non-facility settings. This is based on 0.8 total RVUs (0.5 work RVU, 0.17 PE RVU, 0.13 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 93565 be billed alone or does it require a primary procedure code?

CPT 93565 is an add-on code and cannot be billed alone. It must be reported with a primary cardiac catheterization code from the 93451-93461 range. Billing 93565 without an appropriate primary code will result in denial.

What is the difference between CPT 93565 and 93566?

CPT 93565 represents selective injection into the left ventricle or left atrium during cardiac catheterization, while 93566 represents selective injection into the right atrium or right ventricle. The anatomical location of the injection determines which code to use.

How many times can CPT 93565 be billed during a single catheterization session?

Typically, CPT 93565 is reported once per session even if both left ventricular and left atrial injections are performed, as most payers consider this inclusive. Some payers may allow separate reporting with modifier 59, but this requires clear documentation of distinct medical necessity for each injection and varies by payer policy.

What documentation is required to support billing CPT 93565?

Required documentation includes confirmed catheter position in the left ventricle or left atrium, contrast type and volume, medical indication for selective injection, injection technique, separate interpretation of the ventriculogram or atrialogram, and clear distinction from non-selective or coronary injections performed during the same procedure.

Is CPT 93565 subject to the multiple procedure payment reduction (MPPR)?

No, CPT 93565 is not typically subject to MPPR as it is an add-on code designed to be reported with primary catheterization procedures. However, when multiple injection codes are reported together, bundling edits and payer-specific policies may reduce or deny payment without appropriate modifiers and documentation.

What are the most common denial reasons for CPT 93565?

The most common denials include: bundling with the primary catheterization code due to payer misinterpretation, lack of documented medical necessity for selective injection, insufficient documentation distinguishing it from non-selective injections, and duplicate billing issues when reported with other injection codes without appropriate modifiers.