CPT 93582Cardiology

Perq transcath closure pda

CPT code 93582 covers a minimally invasive heart procedure to close a patent ductus arteriosus (PDA), an abnormal blood vessel connection that should have closed after birth but remained open. The procedure uses a catheter inserted through blood vessels to place a closure device without open-heart surgery.

Showing rates for

National Average

Base Medicare rate

$626.23

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

12.31

PE RVU (NF)

4.25

MP RVU

2.8

Total RVU

19.36

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

NCCI bundling edits

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Billing tips

Document all pre-deployment angiography, hemodynamic measurements, and post-deployment imaging as these are included in 93582 and should not be separately billed
Impact: Prevents unbundling denials that can result in losing the entire $626.23 payment and potential audit flags
Verify the PDA closure is performed via percutaneous transcatheter approach; if thoracotomy or sternotomy is used, this becomes a surgical code (33820-33824) with different reimbursement
Impact: Using incorrect code family can result in underpayment of $2,000-5,000 as surgical codes typically reimburse higher for open procedures
Ensure facility bills separately for the closure device itself using appropriate supply codes; 93582 covers only the physician professional service
Impact: Device costs range $8,000-15,000 and are facility responsibility; physician billing device creates compliance issues and claim denials
Do not separately bill diagnostic cardiac catheterization codes (93451-93461) on same date unless pre-procedure diagnostic cath revealed unexpected findings that changed treatment plan
Impact: Inappropriately bundled diagnostic codes will be denied; if medically necessary and documented with modifier 59, can add $200-400 to total reimbursement
Bill congenital heart disease diagnosis codes (Q25.0 for PDA) rather than acquired codes to support medical necessity and prevent denials
Impact: Incorrect diagnosis coding is a top denial reason; using acquired heart disease codes can trigger automatic denials requiring time-consuming appeals
For adult patients over 21, ensure prior authorization is obtained as many payers consider PDA closure in adults investigational without documented hemodynamic significance

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 93582 in 2025?

The 2025 Medicare national average reimbursement for CPT 93582 is $626.23 for both facility and non-facility settings. This rate is based on 19.36 total RVUs (12.31 work RVU, 4.25 PE RVU, 2.8 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 93582 be billed with a diagnostic cardiac catheterization on the same day?

Generally no, unless the diagnostic catheterization was separately identifiable and revealed unexpected findings that led to the decision to perform PDA closure. If both are medically necessary, append modifier 59 to the diagnostic catheterization code and provide detailed documentation explaining why the diagnostic study was not part of the planned PDA closure procedure.

What is the difference between CPT 93582 and surgical PDA closure codes?

CPT 93582 is for percutaneous transcatheter PDA closure performed through blood vessels without surgical incision. Surgical PDA closure codes (33820-33824) are used when the procedure requires thoracotomy or sternotomy with direct surgical ligation or division of the PDA. The approach used determines which code family to bill.

Do I need prior authorization for CPT 93582?

Prior authorization requirements vary by payer but are commonly required for CPT 93582, especially for adult patients or when performed in outpatient settings. Medicare Advantage plans frequently require authorization, while traditional Medicare typically does not, though medical necessity must still be documented. Always verify with the specific payer before scheduling.

What diagnosis code should be used with CPT 93582?

The primary diagnosis code should be Q25.0 (Patent ductus arteriosus) for congenital PDA. Supporting diagnosis codes may include I50.9 (Heart failure) or I27.2 (Pulmonary hypertension) if present. Avoid using acquired cardiovascular disease codes as the primary diagnosis, as PDA is a congenital condition and incorrect coding can trigger denials.

How many RVUs is CPT 93582 worth in 2025?

CPT 93582 has 19.36 total RVUs in 2025, consisting of 12.31 work RVUs, 4.25 practice expense RVUs (both facility and non-facility), and 2.8 malpractice RVUs. This relatively high RVU value reflects the technical complexity and physician work involved in transcatheter structural heart interventions.

Can CPT 93582 be performed in an ambulatory surgery center?

Yes, CPT 93582 can be performed in an ambulatory surgery center (ASC) that has appropriate cardiac catheterization laboratory capabilities, fluoroscopy, hemodynamic monitoring, and emergency response capabilities. However, ASC reimbursement rates differ from hospital outpatient and physician rates, and some payers may have facility type restrictions requiring hospital-based performance for complex congenital cases.