Perq transcath cls aortic
CPT code 93591 covers a minimally invasive heart procedure where doctors use a catheter inserted through the skin to repair leaks around heart valves without open surgery.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document whether the paravalvular leak is aortic or mitral position and specify the number, size, and location of defects closed, as multiple defects may justify modifier 22 for increased complexity
Impact: Modifier 22 with strong documentation can increase reimbursement by $168-$420 (20-50% above base $840.36 rate)
Separately report fluoroscopic guidance (76000) and intracardiac echocardiography (93662) or transesophageal echocardiography (93355) as these imaging modalities are essential but not bundled into 93591
Impact: Additional $150-$400 in reimbursement for imaging guidance services that are critical to the procedure
Verify that all pre-procedure diagnostic catheterization or coronary angiography is billed separately with appropriate modifiers if performed in the same session, as 93591 focuses on the therapeutic closure procedure
Impact: Properly separated diagnostic work can add $200-$600 to total case reimbursement when medically necessary and documented
Ensure documentation includes heart team evaluation, surgical risk assessment justifying percutaneous approach, and failed medical management, as payers increasingly require evidence that transcatheter closure is medically appropriate versus repeat surgery
Impact: Comprehensive documentation reduces denial risk which otherwise results in $840.36 payment loss and costly appeal processes
Code closure of multiple distinct paravalvular leaks separately only when clinically appropriate and document each defect location, size, and device used, as some payers may consider multiple closures inclusive
Impact: When properly documented, closure of additional distinct defects with modifier 59 can add $420-$630 (50-75% of additional code value)
Bill facility and professional components correctly based on practice setting; in hospital-based practices, ensure professional component modifier 26 is appended to any imaging supervision codes
Impact: Prevents overpayment recovery audits and ensures compliant billing; modifier 26 typically represents 30-40% of total imaging code value
Common denials
Medical necessity denial based on insufficient documentation of heart failure symptoms, hemolysis, or significant paravalvular regurgitation severity warranting intervention
How to appeal: Submit comprehensive appeal with echocardiography reports quantifying regurgitation severity, heart team documentation discussing surgical risk scores (STS/EuroSCORE), cardiology consultation notes documenting symptoms and failed medical therapy, and clinical guidelines supporting transcatheter closure for high-risk surgical patients
Denial for lack of prior authorization or failure to meet payer-specific criteria requiring multidisciplinary heart team evaluation and documentation of prohibitive surgical risk
How to appeal: Provide heart team conference notes with participation from cardiac surgery, interventional cardiology, and imaging specialists; include surgical risk calculator results; cite ACC/AHA guidelines on appropriateness of transcatheter interventions; if emergent, document clinical urgency precluding prior authorization
Bundling denial when billed with same-session diagnostic catheterization or imaging codes that payer considers inclusive of the primary procedure
How to appeal: Appeal with operative report clearly delineating distinct diagnostic work performed prior to decision to proceed with closure; cite CPT guidelines and NCCI edits showing services are separately reportable; use modifier 59 appropriately for distinct procedural services; provide time documentation showing separate decision-making
Experimental or investigational procedure denial, particularly from payers who have not established coverage policies for transcatheter paravalvular leak closure
How to appeal: Submit published clinical evidence supporting efficacy and safety of transcatheter PVL closure; provide FDA device approval documentation; include coverage policies from other major payers recognizing the procedure; cite medical necessity based on patient's specific clinical circumstances and lack of reasonable alternatives
Frequently asked questions
What is the Medicare reimbursement rate for CPT code 93591 in 2025?
The 2025 Medicare national average reimbursement rate for CPT code 93591 is $840.36 for both facility and non-facility settings. This rate 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. Actual payment may vary based on geographic locality adjustments.
Can CPT 93591 be billed with diagnostic cardiac catheterization codes on the same day?
Yes, diagnostic catheterization codes may be billed separately when performed prior to the decision to proceed with paravalvular leak closure, but require appropriate modifier use (typically modifier 59) and clear documentation that diagnostic work was distinct and necessary. The operative report must clearly distinguish the diagnostic portion from the therapeutic closure procedure and justify why diagnostic information was needed before proceeding with intervention.
What documentation is required to support medical necessity for CPT 93591?
Medical necessity documentation must include echocardiographic evidence of significant paravalvular regurgitation with quantitative measurements, symptoms attributable to the leak (heart failure, hemolysis), heart team evaluation discussing surgical risk, evidence that the patient is high-risk for repeat cardiac surgery (STS score or other risk assessment), and documentation of failed medical management. Pre-authorization often requires submission of imaging studies and multidisciplinary team conference notes.
How many RVUs is CPT code 93591 worth in 2025?
CPT code 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 high RVU value reflects the complex interventional nature of transcatheter paravalvular leak closure requiring advanced technical skills and significant physician work.
What imaging codes can be billed separately with CPT 93591?
Intracardiac echocardiography (93662), transesophageal echocardiography (93355 with modifier 26 for professional component), and fluoroscopic guidance (76000) are typically separately reportable with CPT 93591 when performed and documented. These imaging modalities are essential for guiding device placement and confirming closure but are not bundled into the base procedural code. Always verify current NCCI edits and payer-specific bundling policies.
What is a paravalvular leak and when does it require closure?
A paravalvular leak is a gap between a prosthetic heart valve and the native tissue where it is sewn, allowing blood to flow backward around (not through) the valve. Closure with CPT 93591 is indicated when the leak causes significant symptoms such as heart failure, hemolytic anemia requiring transfusions, or evidence of severe regurgitation on imaging, particularly in patients who are high-risk for repeat open-heart surgery. The decision requires heart team evaluation weighing risks and benefits.
Which medical specialties typically perform and bill CPT code 93591?
CPT 93591 is primarily performed and billed by interventional cardiologists with specialized training in structural heart interventions. Structural heart specialists, advanced heart failure cardiologists with interventional skills, and occasionally cardiothoracic surgeons with hybrid procedure expertise may perform this procedure. The procedure requires institutional credentialing, specific training in transcatheter valve interventions, and typically occurs in academic medical centers or advanced cardiac care facilities with comprehensive structural heart programs.