CPT 93580Cardiology

Transcath closure of asd

CPT code 93580 covers a minimally invasive heart procedure where a doctor uses a catheter (thin tube) threaded through blood vessels to close an abnormal opening between the upper chambers of the heart (atrial septal defect or ASD).

Showing rates for

National Average

Base Medicare rate

$923.49

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

17.97

PE RVU (NF)

6.59

MP RVU

3.99

Total RVU

28.55

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

NCCI bundling edits

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Billing tips

Bill 93580 as a standalone comprehensive code that includes all right and left heart catheterization, angiography, fluoroscopy, echocardiographic guidance, device deployment, and post-deployment imaging performed during the ASD closure session
Impact: Prevents unbundling denials worth hundreds of dollars; separately billing included services like 93451, 93452, or 93303 will result in denial and potential audit flags
Document the ASD diameter measurements from multiple imaging modalities (TEE, ICE, fluoroscopy), device size selected, deployment technique, and post-deployment assessment of residual shunt to support medical necessity and proper device coding
Impact: Comprehensive documentation supports the full $923.49 reimbursement and protects against 15-30% payment reductions from medical necessity denials
Verify patient has completed pre-procedure TEE or ICE assessment confirming suitable anatomy (adequate septal rims >5mm except aortic rim, defect size <38mm) as this supports medical necessity; contraindications include sinus venosus or primum ASDs
Impact: Prevents denials for inappropriate patient selection; unsuitable anatomy denials result in zero payment and may require return of the $8,000-15,000 device cost to hospital
When ASD closure is performed with other structural interventions during same session, carefully review CMS bundling rules; balloon atrial septostomy (92992) and some valvuloplasty codes may bundle
Impact: Proper modifier use with distinct procedures can preserve $900+ in additional reimbursement; incorrect bundling/unbundling risks compliance issues
Submit claims with both diagnosis codes for ASD (Q21.1 for congenital) and any associated conditions (I51.0 for cardiac septal defect acquired, I50.9 for heart failure) to support medical necessity, but ensure primary diagnosis is the defect being closed

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Common denials

Bundling denial - payer states that cardiac catheterization codes (93451, 93452, 93453, 93456, 93457) or echocardiography codes (93303, 93312, 93662) should not be billed separately with 93580

How to appeal: Appeal with CPT guidelines showing 93580 is a comprehensive code including all catheterization and imaging for the closure procedure. Reference CPT parenthetical notes and CMS NCCI edits. Submit operative report highlighting that all services were integral to the single ASD closure procedure.

Medical necessity denial stating ASD does not meet criteria for closure (small defect size <5mm, lack of right heart volume overload, insufficient documentation of hemodynamic significance or paradoxical embolism risk)

How to appeal: Submit pre-procedure echocardiogram showing defect size, right heart dilation (RV/LV ratio >1.2), Qp:Qs ratio >1.5:1, or evidence of paradoxical embolism. Include clinical notes documenting symptoms, exercise limitations, or stroke/TIA history. Cite ACC/AHA guidelines for ASD closure indications with supporting hemodynamic data.

Experimental/investigational denial for certain ASD types (multiple fenestrations, patent foramen ovale reclassified as small ASD) or off-label device use

How to appeal: Provide FDA approval documentation for the specific device used for ASD closure (Amplatzer, Gore Cardioform, etc.). Submit literature supporting standard-of-care status for transcatheter ASD closure. Clarify diagnosis coding distinguishing true ASD (Q21.1) from PFO. Include professional society guidelines (ACC/AHA) supporting device closure.

Lack of prior authorization or failure to meet payer-specific criteria requiring failed medical management, specific age ranges, or facility accreditation requirements

How to appeal: Submit retro-authorization request with complete clinical documentation, pre-procedure imaging, and medical necessity rationale. Provide evidence of facility accreditation for structural heart procedures. Document any urgent/emergent circumstances preventing prior authorization. Reference state insurance regulations regarding timely authorization requirements.

Frequently asked questions

What is the Medicare reimbursement rate for CPT 93580 in 2025?

The 2025 Medicare national average reimbursement for CPT 93580 is $923.49 for both facility and non-facility settings. This rate is based on 28.55 total RVUs (17.97 work RVU + 6.59 practice expense RVU + 3.99 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can I bill cardiac catheterization codes separately with 93580?

No, CPT 93580 is a comprehensive code that includes all cardiac catheterization, angiography, imaging supervision and interpretation, and closure device deployment performed during the ASD closure session. Separately billing codes like 93451, 93452, 93453, or echocardiography codes 93303/93312 will result in bundling denials. All these services are considered inclusive to the ASD closure procedure.

What documentation is required to bill CPT 93580 without denials?

Required documentation includes pre-deployment ASD measurements from multiple imaging modalities, specific device information (manufacturer, model, size, lot number), fluoroscopic and echocardiographic confirmation of device positioning, post-deployment assessment of residual shunt, medical necessity justification (symptoms, hemodynamic data showing Qp:Qs >1.5, or embolic risk), and complete procedural narrative describing access, deployment technique, and any complications encountered.

What modifiers are commonly used with CPT 93580?

Modifier 22 is used for increased procedural complexity due to multiple defects or challenging anatomy (with 20-30% payment increase). Modifier 62 applies when two surgeons work as co-surgeons (each receives 62.5% payment). Modifier 53 indicates discontinued procedure due to complications or unsuitable anatomy. Modifier 76 is used for repeat procedures by the same physician. Each modifier requires specific documentation to support the additional payment or circumstance.

What are the medical necessity criteria for ASD closure with CPT 93580?

Medical necessity typically requires hemodynamically significant ASD with right heart volume overload (RV/LV ratio >1.2, Qp:Qs >1.5:1), symptoms attributable to the defect (dyspnea, exercise intolerance), history of paradoxical embolism or stroke, suitable anatomy for device closure (secundum ASD typically 4-38mm with adequate septal rims >5mm), and appropriate patient risk profile making transcatheter approach preferable to surgical closure.

How many RVUs is CPT code 93580 worth in 2025?

CPT 93580 has a total of 28.55 RVUs in 2025, consisting of 17.97 work RVUs, 6.59 practice expense RVUs (both facility and non-facility), and 3.99 malpractice RVUs. This makes it a high-value interventional cardiology procedure reflecting the technical complexity and professional work involved in transcatheter ASD closure.

What is the difference between CPT 93580 and 93581?

CPT 93580 covers transcatheter closure of atrial septal defect (ASD), an abnormal opening between the upper heart chambers. CPT 93581 covers transcatheter closure of ventricular septal defect (VSD), an opening between the lower heart chambers. While both are structural heart closure procedures using similar catheter-based techniques, they address different anatomic defects, have different device requirements, and carry distinct procedural risks and reimbursement rates.