CPT 93569Cardiology

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CPT code 93569 covers injection procedures during cardiac catheterization to obtain x-ray images (angiography) of the pulmonary arteries on one side of the lungs. This helps doctors visualize blood flow and detect blockages or abnormalities in the lung's blood vessels.

Showing rates for

National Average

Base Medicare rate

$35.58

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

0.78

PE RVU (NF)

0.27

MP RVU

0.05

Total RVU

1.1

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

NCCI bundling edits

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Billing tips

Always verify primary catheterization code is billed first as 93569 is an add-on code (List Separately in Addition to Primary Procedure) and cannot be billed alone
Impact: Prevents automatic denial; ensures $35.58 payment is not rejected for missing primary procedure code
Document which pulmonary artery (right or left) was selectively catheterized and include number of injections and views obtained in procedure note
Impact: Supports medical necessity and prevents downcoding or denial; required for audit defense
Do not bill 93569 twice for bilateral pulmonary artery angiography; use 93568 instead for bilateral selective imaging
Impact: Prevents overbilling and audit flags; 93568 has higher reimbursement than billing 93569 twice
Ensure contrast injection and imaging interpretation are both documented; passive catheter placement without injection does not support 93569
Impact: Missing documentation of injection or interpretation triggers 100% denial on appeal review
Check National Correct Coding Initiative (NCCI) edits before billing with other cardiac catheterization codes to avoid bundling denials
Impact: Prevents initial denial and reduces administrative burden of appeals; saves 30-45 days in payment cycle
Bill in facility setting when performed in hospital or ASC to receive full $35.58 facility rate; same rate applies for non-facility
Impact: No rate differential exists between settings for this code; ensures consistent $35.58 reimbursement

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 93569 in 2025?

The 2025 Medicare national average reimbursement for CPT 93569 is $35.58 for both facility and non-facility settings. This rate is calculated using a total RVU of 1.1 (Work RVU: 0.78, PE RVU: 0.27, MP RVU: 0.05) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 93569 be billed alone or does it require a primary procedure code?

CPT 93569 cannot be billed alone as it is an add-on code (designated by the + symbol in CPT manual). It must be reported in conjunction with a primary cardiac catheterization procedure code such as 93451-93461. Billing 93569 without an appropriate primary code will result in automatic denial.

What is the difference between CPT 93568 and 93569?

CPT 93568 is for bilateral selective pulmonary artery angiography (both right and left pulmonary arteries), while CPT 93569 is for unilateral selective pulmonary artery angiography (either right or left, but not both). Do not bill 93569 twice for bilateral procedures; use 93568 instead.

What documentation is required to support billing CPT 93569?

Required documentation includes the specific pulmonary artery catheterized (right or left), contrast type and volume injected, number and orientation of imaging views, physician interpretation of findings, medical necessity justification, and clear indication that this was performed as a selective procedure beyond routine catheterization.

How many RVUs is CPT code 93569 worth in 2025?

CPT 93569 has a total of 1.1 RVUs in 2025, consisting of 0.78 Work RVUs, 0.27 Practice Expense RVUs (both facility and non-facility), and 0.05 Malpractice RVUs based on the CMS Physician Fee Schedule.

What are common reasons for denial of CPT 93569 claims?

Common denial reasons include billing without a primary catheterization code, insufficient documentation of selective catheterization technique, lack of medical necessity documentation, inappropriate bundling with comprehensive cath codes, and missing contrast injection or imaging interpretation documentation.

Which medical specialties typically bill CPT code 93569?

CPT 93569 is primarily billed by interventional cardiologists, pediatric cardiologists, adult congenital heart disease specialists, and some cardiac surgeons who perform invasive cardiac catheterization procedures with selective pulmonary artery imaging in hospital catheterization laboratories or specialty cardiac centers.