Perq transcath cls mitral
CPT 93590 covers percutaneous (through the skin) transcatheter closure of the mitral valve, a minimally invasive heart procedure to repair a leaking mitral valve without open-heart surgery. This advanced procedure uses a catheter inserted through a blood vessel to reach and repair the valve between the left atrium and left ventricle.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Always verify medical necessity documentation includes heart team evaluation, transthoracic and transesophageal echocardiography reports demonstrating severe mitral regurgitation (grade 3-4+), and documentation of surgical risk assessment (STS score or other validated tool)
Impact: Missing heart team documentation is the #1 denial reason, resulting in loss of entire $1013.74 reimbursement; comprehensive pre-procedure documentation reduces denial rate by approximately 75%
Bill 93590 only once per session regardless of number of clips deployed; multiple clip deployments during same procedure are included in the single code and should not be billed with units greater than 1
Impact: Billing multiple units results in automatic denial and potential fraud investigation; proper single-unit billing prevents overpayment recovery demands
Do not separately bill transseptal catheterization (93462), fluoroscopic guidance (76000), or intracardiac echocardiography (93662) as these are bundled into 93590 per CMS NCCI edits
Impact: Unbundling these services triggers audits and requires repayment; keeping services bundled prevents approximately $300-500 in denied ancillary charges per case
Ensure operative report explicitly documents device name, size, number of devices deployed, deployment success, and pre/post-procedure mitral regurgitation grade with supporting imaging findings
Impact: Incomplete device documentation leads to 40% of medical record review denials; complete documentation supports full reimbursement and withstands audit scrutiny
Verify place of service code matches actual location (21 for inpatient hospital, 22 for hospital outpatient); Medicare pays identical facility rate of $1013.74 for both settings in 2025
Impact: Incorrect place of service triggers claims processing delays of 30-60 days; correct coding ensures timely payment without manual review
For bilateral or staged procedures, if patient requires repeat procedure on same valve within global period, append modifier 58 for planned staged procedure or 76 for repeat procedure by same physician
Impact: Proper modifier use allows payment for necessary repeat procedures that would otherwise be denied as included in global period; protects estimated $1000+ in legitimate charges
Common denials
Medical necessity denial due to insufficient documentation of heart team evaluation or lack of evidence patient is high-risk surgical candidate
How to appeal: Submit complete heart team conference notes, all echocardiography reports showing MR severity, surgical risk calculator results (STS score), and documentation of comorbidities precluding open surgery; include peer-reviewed literature supporting transcatheter approach for patient's specific risk profile; request peer-to-peer review with medical director
Denial for experimental/investigational procedure when billed for off-label indications or patient doesn't meet FDA-approved device criteria
How to appeal: Provide FDA approval documentation for specific device and indication, cite national coverage determination (NCD) or local coverage determination (LCD) supporting coverage, submit clinical studies demonstrating efficacy for patient's specific anatomy/pathology, and document shared decision-making discussion with patient regarding risks/benefits
Bundling denial when billed with diagnostic cardiac catheterization (93451-93464) performed same session without modifier 59
How to appeal: If diagnostic catheterization was performed for distinct diagnostic purpose prior to decision to proceed with repair, resubmit with modifier 59 on diagnostic code and separate procedure note clearly documenting diagnostic findings that led to decision to proceed; demonstrate diagnostic study was not pre-planned as part of repair procedure
Denial for exceeding facility or physician credential requirements, or procedure not performed at approved structural heart center
How to appeal: Submit physician credentialing documentation including board certification, structural heart training certificates, hospital privileges specific to transcatheter mitral procedures, and facility accreditation as structural heart program; provide proctorship documentation if applicable for newer operators
Frequently asked questions
What is the Medicare reimbursement rate for CPT code 93590 in 2025?
The 2025 Medicare national average reimbursement for CPT 93590 is $1013.74 for both facility and non-facility settings. This is based on 31.34 total RVUs (21.7 work RVU, 7.91 practice expense RVU, and 1.73 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.
Can CPT 93590 be billed with a diagnostic cardiac catheterization on the same day?
Generally no, diagnostic cardiac catheterization codes (93451-93464) are bundled with 93590 per NCCI edits. However, if a separate diagnostic catheterization was performed for distinct diagnostic purposes before the decision to proceed with mitral repair, modifier 59 may be appended to the diagnostic code with clear documentation supporting the separate nature of the procedures.
How many RVUs is CPT code 93590 worth?
CPT 93590 has a total of 31.34 RVUs for 2025, comprised of 21.7 work RVUs, 7.91 practice expense RVUs (both facility and non-facility), and 1.73 malpractice RVUs. This high RVU value reflects the complexity and resource intensity of transcatheter mitral valve repair procedures.
What documentation is required to support medical necessity for CPT 93590?
Required documentation includes heart team evaluation notes, echocardiography reports demonstrating moderate-to-severe or severe mitral regurgitation (grade 3+ or 4+), surgical risk assessment using validated tools (STS score), documentation that patient is high-risk or inoperable for traditional surgery, and evidence of symptomatic heart failure despite optimal medical therapy. All elements must be present to meet medical necessity criteria.
Should I bill CPT 93590 multiple times if multiple clips are deployed?
No, CPT 93590 should only be billed once per procedure session regardless of the number of clips or devices deployed. Multiple device deployments during the same session are included in the single code. Billing multiple units will result in denial and potential audit.
What is the difference between CPT 93590 and 93591?
CPT 93590 describes percutaneous transcatheter closure of the mitral valve (edge-to-edge repair such as MitraClip), while CPT 93591 describes percutaneous transcatheter implantation or replacement of the mitral valve (valve replacement procedures such as transcatheter mitral valve replacement or TMVR). The codes represent fundamentally different approaches: repair versus replacement.
Who can bill CPT 93590 and what credentials are required?
CPT 93590 can be billed by board-certified interventional cardiologists or cardiothoracic surgeons with specialized training in structural heart interventions. Physicians must have hospital credentialing specific to transcatheter mitral procedures, completion of device-specific training, and often require proctored cases. Most programs require a multidisciplinary heart team approach including cardiac anesthesiology and echocardiography support.