CPT 93590Cardiology

Perq transcath cls mitral

CPT code 93590 covers percutaneous transcatheter closure of the mitral valve, a minimally invasive procedure to repair a leaky mitral heart valve using a catheter inserted through the skin rather than open-heart surgery.

Showing rates for

National Average

Base Medicare rate

$1,013.74

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

21.7

PE RVU (NF)

7.91

MP RVU

1.73

Total RVU

31.34

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

NCCI bundling edits

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Billing tips

Ensure separate documentation of all imaging guidance (fluoroscopy, transesophageal echocardiography) performed during the procedure, as imaging professional and technical components may be separately billable
Impact: Additional reimbursement of $200-800 depending on imaging modalities documented and billed separately
Bill on the date of service when the percutaneous closure device is deployed, not the date of pre-procedure imaging or post-procedure follow-up; only one unit of 93590 per session regardless of number of clips or devices placed
Impact: Prevents automatic denials for incorrect date of service; billing multiple units results in 100% denial of duplicate charges
Document medical necessity including failed medical management, symptom severity (NYHA class), mitral regurgitation grade, and heart team evaluation supporting percutaneous approach over surgical intervention
Impact: Reduces denial risk by 60-70%; absence of medical necessity documentation is primary denial reason for high-cost structural procedures
Verify prior authorization requirements with specific payer before scheduling; most Medicare Advantage and commercial plans require pre-authorization for 93590 with 30-60 day advance notice
Impact: Prevents complete payment denial; unauthorized cases may result in $0 payment despite $1013.74 potential reimbursement
Do not unbundle and separately bill cardiac catheterization codes (93451-93464) when performed during the same session as 93590; diagnostic catheterization is included unless performed on different date
Impact: Prevents modifier 59 denials and potential fraud allegations; improper unbundling may trigger comprehensive claim audits

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 93590 in 2025?

The 2025 Medicare national average reimbursement rate for CPT code 93590 is $1013.74 for both facility and non-facility settings. This rate is based on 31.34 total RVUs (21.7 work RVU, 7.91 PE RVU, 1.73 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Does CPT 93590 include diagnostic cardiac catheterization?

Yes, diagnostic cardiac catheterization and coronary angiography performed on the same date as the percutaneous mitral valve repair (93590) are typically bundled and should not be billed separately. Only if diagnostic catheterization is performed on a separate date and leads to the decision for intervention can it be separately reported.

Can you bill CPT 93590 more than once if multiple clips are placed?

No, CPT 93590 should only be reported once per session regardless of the number of clips or devices deployed during the percutaneous mitral valve repair procedure. The code describes the complete percutaneous transcatheter closure procedure, not individual device placements.

What modifiers are most commonly used with CPT 93590?

The most common modifiers for 93590 are modifier 62 (co-surgeons) when an interventional cardiologist and cardiac surgeon work together, modifier 80 (assistant surgeon) when additional physician assistance is required, and modifier 22 (increased procedural services) for cases with significantly greater complexity than typical.

Is prior authorization required for CPT code 93590?

Most payers including Medicare Advantage plans and commercial insurance require prior authorization for CPT 93590 due to the high cost and specific coverage criteria. Traditional Medicare Part B typically does not require prior authorization but has specific coverage requirements. Verify authorization requirements with the specific payer 30-60 days before the scheduled procedure.

What documentation is needed to support medical necessity for CPT 93590?

Required documentation includes echocardiographic evidence of moderate-to-severe or severe mitral regurgitation, heart team evaluation supporting percutaneous approach, surgical risk assessment (STS score), failed medical management documentation, NYHA functional class, patient symptoms, and rationale for choosing percutaneous over surgical repair based on patient risk factors and anatomic suitability.

How many work RVUs is CPT code 93590 worth in 2025?

CPT code 93590 has 21.7 work RVUs in 2025, reflecting the significant physician work involved in performing percutaneous transcatheter mitral valve closure. The total RVU value is 31.34 when including practice expense (7.91) and malpractice (1.73) components.