CPT 93571Cardiology

Heart flow reserve measure

CPT code 93571 represents the measurement of coronary flow reserve, a diagnostic test that evaluates how well blood flows through the heart's arteries during stress compared to rest. This non-invasive measurement helps doctors assess the severity of coronary artery disease and determine if blockages are limiting blood flow to the heart muscle.

Showing rates for

National Average

Base Medicare rate

$68.25

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

1.38

PE RVU (NF)

0.48

MP RVU

0.25

Total RVU

2.11

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

NCCI bundling edits

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Billing tips

Bill 93571 separately for each coronary vessel assessed, not per lesion; use modifier XS or 59 for additional vessels beyond the first
Impact: Can increase revenue by $68.25 per additional vessel when properly documented and medically necessary
Ensure documentation includes both baseline and hyperemic flow velocity measurements, the calculation of CFR ratio, and clinical interpretation
Impact: Reduces denial rate by approximately 60-70% compared to incomplete documentation
Do not bill 93571 with FFR code 93571 on the same vessel; these are mutually exclusive measurements requiring distinct documentation
Impact: Prevents automatic denials and recoupment of $68.25 per incorrectly bundled service
Verify that the pharmacologic agent used for hyperemia (adenosine, regadenoson) is separately documented and billed with appropriate drug codes
Impact: Captures additional reimbursement for medications which are not included in the 93571 payment
Link 93571 to specific diagnosis codes indicating intermediate coronary stenosis or angina evaluation (I25.10, I25.110-119, I20.x)
Impact: Improves first-pass acceptance rate by 40-50% and establishes medical necessity
Bill on the same claim as the base catheterization procedure (93454-93461) to demonstrate the flow reserve was performed during the same session
Impact: Streamlines adjudication and reduces coordination of benefits delays by 2-3 weeks on average

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 93571 in 2025?

The 2025 Medicare national average reimbursement for CPT 93571 is $68.25 for both facility and non-facility settings. This rate is based on 2.11 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the GPCI adjustment.

Can CPT 93571 be billed with cardiac catheterization codes?

Yes, CPT 93571 is an add-on code designed to be billed with base cardiac catheterization codes (93454-93461). It represents a separate diagnostic service beyond the standard angiography and is not bundled into the catheterization procedure when properly documented. Bill on the same claim to show they were performed during the same session.

How many times can I bill CPT 93571 during a single catheterization?

You can bill CPT 93571 for each coronary vessel where flow reserve is measured, not per lesion. Most payers allow billing for 2-3 vessels when medically necessary and properly documented. Use modifier XS or 59 for the second and subsequent vessels to indicate separate anatomic sites.

What is the difference between CPT 93571 and FFR measurement?

CPT 93571 measures coronary flow reserve (CFR), which is the ratio of hyperemic to baseline flow velocity, while FFR measures the pressure gradient across a stenosis. CFR assesses both epicardial and microvascular function, whereas FFR specifically evaluates epicardial stenosis severity. They use different measurement techniques and should not be billed together on the same vessel.

What documentation is required to bill CPT 93571?

Required documentation includes the indication for CFR measurement, specific vessel assessed, type of measurement technology, pharmacologic agent used for hyperemia with dosage, both baseline and hyperemic flow velocity measurements, calculated CFR ratio, and clinical interpretation affecting treatment decisions. Flow velocity tracings should be part of the catheterization report.

Does CPT 93571 require modifier 26 for professional component?

CPT 93571 is typically billed as a global service in the cardiac catheterization lab setting. Modifier 26 would only be appropriate if billing solely the professional interpretation component when the facility separately bills the technical component, which is uncommon for this intra-procedural measurement. The $68.25 rate represents the complete global service.

What are common denial reasons for CPT 93571?

The most common denials include: bundling with the base catheterization procedure, medical necessity questions when angiography shows clear findings, incomplete documentation missing CFR ratio calculation, and duplicate billing when performed with FFR on the same vessel. Proper documentation of the distinct diagnostic value and complete flow measurements prevents most denials.