CPT 93572Cardiology

Heart flow reserve measure

CPT 93572 covers the measurement of coronary flow reserve, a diagnostic test that evaluates how well blood flows through the heart's arteries during rest and stress conditions to detect blockages.

Showing rates for

National Average

Base Medicare rate

$49.49

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

PE RVU (NF)

0.35

MP RVU

0.18

Total RVU

1.53

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

NCCI bundling edits

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Billing tips

Always bill 93572 as an add-on code with a primary cardiac catheterization procedure code (93454-93461); it cannot be billed alone
Impact: Prevents automatic denial for missing primary procedure; ensures $49.49 payment is processed correctly
Document both resting and hyperemic flow velocity measurements with specific numeric values and the calculated flow reserve ratio
Impact: Critical for audit defense; lack of specific measurements can result in 100% claim denial and recoupment
Identify the specific coronary vessel(s) measured and the method of hyperemia induction (adenosine IV, IC adenosine, regadenoson, etc.)
Impact: Strengthens medical necessity documentation and reduces denial rate by approximately 35-40%
Bill only once per catheterization session regardless of number of vessels measured, unless measuring distinct territories at separate sessions
Impact: Prevents overbilling and subsequent recoupment; multiple units typically denied with 100% payment reversal
Verify that your facility's cardiac cath lab has the proper Doppler or thermodilution wire equipment documented in inventory for CFR measurements
Impact: Equipment documentation supports medical review appeals and can prevent retrospective denials
Link appropriate ICD-10 codes for coronary artery disease (I25.10, I25.110-I25.119) or chest pain (R07.9) to establish medical necessity
Impact: Improves first-pass claim acceptance rate by 20-30% compared to non-specific diagnosis codes

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 93572 in 2025?

The 2025 Medicare national average reimbursement for CPT 93572 is $49.49 for both facility and non-facility settings, based on 1.53 total RVUs and the conversion factor of 32.3465.

Can CPT 93572 be billed alone or does it require a primary procedure?

CPT 93572 is an add-on code and cannot be billed alone. It must be reported with a primary cardiac catheterization procedure code such as 93454, 93455, 93456, 93457, 93458, 93459, 93460, or 93461.

How many times can I bill 93572 during a single catheterization session?

CPT 93572 should typically be billed once per catheterization session regardless of the number of vessels measured. Multiple units are generally not supported unless measuring distinct vascular territories at separate procedural sessions with clear documentation.

What documentation is required to support billing CPT 93572?

Required documentation includes baseline and hyperemic flow velocity measurements with specific numeric values, the type and dose of hyperemic agent used, the calculated flow reserve ratio, the specific vessel(s) measured, and the clinical indication for performing the measurement.

What is the difference between CPT 93572 and fractional flow reserve (FFR) codes?

CPT 93572 measures coronary flow reserve using Doppler or thermodilution to assess velocity changes, while FFR codes (93571) measure pressure differences across a stenosis. Both assess lesion significance but use different physiologic parameters and measurement techniques.

Does CPT 93572 require modifier 26 or TC for split billing?

Modifier 26 (professional component) or TC (technical component) can be appended to 93572 when the physician interpretation and technical services are billed separately, though this code is most commonly billed as a global service in the hospital setting.

What are common denial reasons for CPT 93572 and how can I prevent them?

Common denials include billing without a primary catheterization code, insufficient documentation of flow measurements, and lack of medical necessity. Prevention requires always pairing with appropriate primary codes, documenting specific velocity values and ratios, and clearly stating clinical indication for functional assessment.