CPT 93591Cardiology

Perq transcath cls aortic

CPT code 93591 covers a minimally invasive heart procedure where doctors use a catheter (thin tube) inserted through the skin to seal a leak around an artificial heart valve without open surgery.

Showing rates for

National Average

Base Medicare rate

$840.36

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)

6.51

MP RVU

1.5

Total RVU

25.98

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

NCCI bundling edits

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Billing tips

Document all imaging modalities used during the procedure, including fluoroscopy, transesophageal echocardiography (TEE), and any intracardiac echocardiography (ICE). While imaging guidance is included in 93591, comprehensive documentation supports medical necessity and complexity.
Impact: Prevents downcoding or denials challenging medical necessity; supports modifier 22 claims for unusual complexity if applicable
Separately bill for the TEE or ICE imaging supervision and interpretation using appropriate codes (93312-93318 for TEE, 93662 for ICE) as these are not bundled with 93591 when performed by different physicians or separately documented.
Impact: Additional $150-$400 in reimbursement for imaging services when properly documented and criteria met
Code 93591 is facility-only with identical facility and non-facility rates ($840.36), confirming this must be performed in hospital or ASC setting. Never bill as office-based procedure.
Impact: Prevents 100% claim denial; ensures compliance with site-of-service requirements
When multiple paravalvular leaks are closed during the same session, verify payer policy before billing 93591 with modifier 59 or multiple units. Most payers consider multiple leak closures as part of the base code.
Impact: Prevents automatic denials and compliance issues; some commercial payers may allow 1.5x payment with appropriate documentation
Include detailed documentation of the valve involved (aortic, mitral, tricuspid, or pulmonary), whether the original valve was surgical or transcatheter, the size and hemodynamic significance of the leak, and the specific closure device(s) used.
Impact: Supports medical necessity and reduces audit risk; essential for appeals if claim is initially denied

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 93591 in 2025?

The 2025 Medicare national average reimbursement for CPT 93591 is $840.36 for both facility and non-facility settings. This is based on 25.98 total RVUs (17.97 work RVU, 6.51 PE RVU, 1.5 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 93591 be billed with diagnostic cardiac catheterization codes on the same day?

Generally, diagnostic cardiac catheterization codes (93451-93461) are bundled with 93591 when performed on the same date, as the diagnostic component is considered part of the procedure planning. However, if a completely separate diagnostic catheterization was performed earlier in the day before the decision to proceed with closure was made, it may be billable with modifier 59 and comprehensive documentation supporting the distinct nature of the services.

What imaging codes can be separately billed with CPT 93591?

Transesophageal echocardiography (TEE, codes 93312-93318) and intracardiac echocardiography (ICE, code 93662) may be separately billable when performed and interpreted by different physicians or when documentation clearly supports separate, distinct interpretations. However, fluoroscopic guidance is included in 93591 and should not be separately reported.

Does CPT 93591 require prior authorization from Medicare or commercial payers?

Medicare Advantage plans and most commercial payers require prior authorization for CPT 93591 due to the high cost and specialized nature of the procedure. Traditional Medicare (Part B) does not require prior authorization but does require medical necessity documentation. Always verify specific payer requirements before scheduling as authorization requirements vary significantly among plans.

How many RVUs is CPT code 93591 worth in 2025?

CPT 93591 has 25.98 total RVUs in 2025, consisting of 17.97 work RVUs, 6.51 practice expense RVUs (both facility and non-facility), and 1.5 malpractice RVUs. This makes it a high-value procedure code reflecting the complexity and risk of transcatheter paravalvular leak closure.

What is the difference between CPT 93590 and 93591?

CPT 93590 covers percutaneous transcatheter closure of paravalvular leak for initial mitral valve repair, while CPT 93591 specifically describes closure of paravalvular leak around an aortic valve. The codes differ based on which valve is being treated, with separate codes ensuring accurate reporting of the specific intervention performed.

Can CPT 93591 be billed multiple times for closure of multiple paravalvular leaks?

Generally, CPT 93591 is billed once per session regardless of the number of paravalvular leaks closed during that procedure, as closure of multiple defects is considered part of the comprehensive intervention. However, payer policies vary, and some commercial insurers may allow additional reimbursement with modifier 22 for unusual complexity when multiple difficult leak sites are addressed. Always verify specific payer policy and document extensively if billing for increased complexity.