CPT 93592Cardiology

Perq transcath closure each

CPT code 93592 covers the percutaneous (through-skin) transcatheter closure of each structural heart defect, such as closing holes in the heart using a catheter-based device without open surgery.

Showing rates for

National Average

Base Medicare rate

$365.52

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

PE RVU (NF)

2.76

MP RVU

0.54

Total RVU

11.3

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Bill separately for each distinct defect closed using modifier 59 on the second and subsequent closures
Impact: Each additional closure adds $365.52; failure to use modifier 59 results in bundling and loss of payment for additional defects
Document the specific defect type, location, size measurements, device type, and manufacturer details for each closure performed
Impact: Prevents 20-30% of denials related to medical necessity and supports modifier 22 claims for complex cases
Separately bill imaging guidance codes (93355 for TEE, 76000 for fluoroscopy) as these are not bundled with 93592
Impact: Additional $150-300 in reimbursement per case; commonly overlooked ancillary revenue
Verify LCD coverage policies for specific defect types (PFO coverage often requires documented stroke/TIA history)
Impact: Prevents denials; PFO closures without proper indication documentation have 40-60% denial rates
Use modifier 22 with detailed operative note when closing defects >25mm or using multiple devices, including percentage increase requested
Impact: Can increase payment by $73-183 (20-50%) when properly documented with comparison to typical procedure complexity
Confirm prior authorization requirements before procedure; many payers require pre-authorization for structural heart interventions
Impact: Avoids 100% payment denial; retrospective authorization rarely successful for elective procedures

Common denials

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 93592?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT 93592 in 2025?

The 2025 Medicare national average reimbursement for CPT 93592 is $365.52 for both facility and non-facility settings, based on 11.3 total RVUs and the 2025 conversion factor of 32.3465.

Can I bill CPT 93592 multiple times for closing multiple defects in one session?

Yes, you can bill 93592 for each separately closed defect, but you must append modifier 59 to the second and subsequent codes to indicate distinct procedural services. Documentation must clearly support separate anatomical defects requiring individual closure devices.

What documentation is required to support medical necessity for CPT 93592?

Required documentation includes pre-procedure imaging showing defect size and location, clinical indication (symptoms, shunt quantification, or cryptogenic stroke for PFO), hemodynamic assessment, and evidence that closure criteria are met per clinical guidelines or LCD requirements.

Does CPT 93592 include echocardiographic guidance or is that billed separately?

Echocardiographic guidance (TEE code 93355 or ICE code 93662) is billed separately from 93592. Fluoroscopic guidance is also separately billable. These imaging modalities are not bundled into the closure procedure code.

What are the work RVUs for CPT code 93592?

CPT 93592 has 8.0 work RVUs, 2.76 practice expense RVUs (both facility and non-facility), and 0.54 malpractice RVUs, totaling 11.3 RVUs in 2025.

Is prior authorization required for billing CPT 93592?

Prior authorization requirements vary by payer but most commercial insurers and Medicare Advantage plans require pre-authorization for percutaneous structural heart procedures including defect closures. Traditional Medicare does not require prior authorization but may have LCD coverage criteria that must be met.

What is the difference between CPT 93580 and 93592?

CPT 93580 is for percutaneous transcatheter closure of congenital intracardiac shunt (ASD, VSD, or PDA), while 93592 specifically describes each additional closure when multiple defects are closed. Code 93580 is used for the primary/first closure, and 93592 for subsequent closures during the same session.