Cardiac catheterization is a foundational diagnostic and interventional procedure in cardiology, used to evaluate coronary artery disease, assess ventricular function, diagnose valvular disorders, and plan interventions such as PCI or stent placement. Among the most frequently used cath lab CPT codes is 93458, which describes a combined left heart catheterization (LHC) with coronary angiography.
CPT 93458 is one of the highest-value cardiology CPT codes. Because reimbursement is significant and payer scrutiny is high, clean documentation and correct usage are essential.
This in-depth guide explains everything your practice needs to know about billing CPT 93458 — including what it covers, how it differs from similar cath codes, medical necessity, documentation rules, bundling issues, common denials, and payer requirements.
Stay compliant with complex procedural rules using our CPT 93460 Right & Left Heart Catheterization Billing Guide covering documentation, contrast use, and NCCI bundling.
What Is CPT 93458?
Official CPT description:
“Catheter placement in coronary arteries for coronary angiography, including intraprocedural injections for left heart catheterization, imaging supervision and interpretation; left heart catheterization, including intraprocedural injection(s) for left ventriculography, when performed.”
In simple terms:
CPT 93458 = Left heart cath (LHC) + coronary angiography performed during the same session.
This is one of the core diagnostic combinations performed in cath labs.
What CPT 93458 Includes
To use CPT 93458, the following components must be performed in the same encounter:
1. Cardiac Catheter Insertion Into the Left Heart
This includes:
- Arterial access (radial or femoral)
- Advancing the catheter to the left ventricle
- Measuring LV pressures
- LVEDP measurement
- Pullback pressure evaluation
2. Coronary Angiography
Imaging of:
- Left coronary system
- Right coronary system
- Bypass grafts (if applicable, additional codes may apply)
Includes:
- Catheter placement in the coronary arteries
- Contrast injections
- Fluoroscopic imaging
- Image interpretation
3. Imaging Supervision and Interpretation
The physician must:
- Supervise contrast injections
- Interpret the angiographic findings
- Document the coronary anatomy
- Describe stenoses, calcification, plaque characteristics
- Report LV function (if ventriculography is performed)
4. Intraprocedural Hemodynamic Measurements
When medically necessary:
- Aortic pressure
- LV pressure
- LVEDP
- Pullback gradient
All included in CPT 93458. Reduce audit risk and correctly bill emergent PCI cases using our
CPT 92941 Acute MI PCI Billing Guide complete with coding tips, modifier rules, and clinical documentation requirements.
What CPT 93458 Does NOT Include
Do not assume everything is included — several services require additional CPT codes, such as:
❌ Right heart catheterization
Requires 93451 (RHC)
Add-on code 93460 for combined RHC + LHC.
❌ Bypass graft angiography
Requires add-on:
- 93459 for bypass grafts
- 93461 for LHC + RHC + bypass
❌ Instantaneous wave-free ratio (iFR) or FFR
Requires add-on:
- 93571 (first vessel)
- 93572 (additional vessels)
❌ Intravascular ultrasound (IVUS) or OCT
Add-on codes apply.
❌ PCI, angioplasty, or stent placement
Use 92920, 92928, etc.
❌ Moderate sedation
Often separately billable under 99152–99153.
When to Use CPT 93458
Bill 93458, when a provider performs both:
- A left heart catheterization
- Coronary angiography
This is typical in patients with:
- Chest pain
- Acute coronary syndromes
- Abnormal stress test
- Positive high-sensitivity troponin
- Unstable angina
- Known CAD with worsening symptoms
- Heart failure of unclear cause
- Valvular abnormalities requiring LV pressure evaluation
- Pre-operative evaluation before cardiac surgery
When NOT to Use CPT 93458
Do not bill 93458 if:
❌ Only coronary angiography was performed
Use 93454 (coronary angiography without LHC).
❌ Only a left ventriculogram was done (rare)
Requires specific coding.
❌ Right heart catheterization was performed without LHC
Use 93451.
❌ Procedure was performed on a bypass graft only
Use bypass graft code sets (93459, 93461).
❌ Procedure was diagnostic but immediately followed by PCI**
Diagnostic cath may or may not be separately billable depending on guidelines:
- If no prior angiography exists, billable
- If cath was solely to guide an already-planned PCI, not separately billable
Medicare is strict on this point.
Medical Necessity Guidelines for CPT 93458
Payers require clear documentation supporting the use of invasive angiography.
Common medical necessity indications:
- Acute coronary syndrome
- Positive stress test
- New heart failure with reduced EF
- Unstable angina (chest pain at rest)
- Syncope with suspected structural disease
- Pre-op evaluation for CABG or valve surgery
- Abnormal coronary CTA
- Aortic stenosis needing gradient confirmation
- Cardiomyopathy workup
Documentation should reflect:
- Symptoms
- Abnormal non-invasive findings
- Decision-making process
- Alternative tests considered
Documentation Requirements for CPT 93458
To avoid denials, include:
1. Pre-procedure justification
- Symptoms (e.g., chest pain, dyspnea)
- Previous testing
- Indication for invasive evaluation
2. Procedure details
- Vascular access route
- Catheters used
- Coronary arteries examined
- LV pressure measurements
- Contrast administered
3. Imaging interpretation
Must describe:
- Coronary anatomy
- Presence and severity of stenosis
- Location of lesions
- LV functional assessment (if ventriculography is done)
- Any complications
4. Post-procedure outcomes
- Hemostasis method
- Complications
- Follow-up plan
5. Provider signature
Digital or handwritten.
Modifier Use With CPT 93458
Modifiers may apply:
✔ Modifier -59
If bundled services require unbundling (rare in the cath lab).
✔ Modifier -26
If ONLY interpretation is being billed (facility billed TC).
✔ Modifier -52
Reduced services (partial study due to patient intolerance).
✔ Modifier -76 / -77
Repeat procedures.
Typical Reimbursement for CPT 93458
Medicare national average ranges:
- Facility: ~$450–$650
- Professional component: ~$140–$200
Commercial insurance often pays significantly higher, depending on contract rates.
Because of high reimbursement and complexity, payers scrutinize these claims closely. Strengthen your remote device monitoring workflows using our detailed CPT 93272 Pacemaker & ICD Remote Monitoring Billing Guide covering documentation, technical components, and payer rules.
Prior Authorization Requirements
Medicare
- No prior authorization required
- BUT documentation must justify the medical necessity.
Medicare Advantage
- Almost always requires prior authorization
Commercial Plans
Most require PA for:
- Non-emergent diagnostic catheterization
- Stable angina patients
Medicaid
Varies by state; generally requires PA unless emergent.
Emergent Cath Lab Procedures
If performed for:
- STEMI
- Acute coronary syndrome
- Unstable arrhythmia
PA is not required, but documentation must clearly indicate emergency status.
Common Denials for CPT 93458 (and Fixes)
❌ 1. Missing medical necessity
Fix: Add symptoms + abnormal tests + reasoning.
❌ 2. Coding the wrong cath combination
Fix: Confirm whether RHC, bypass grafts, or ventriculography were done.
❌ 3. Procedure bundled into PCI
Fix: Ensure the diagnostic cath wasn’t solely to guide PCI.
❌ 4. Missing interpretation report
Fix: Add full coronary and LV interpretation.
❌ 5. Insufficient hemodynamic documentation
Fix: Document LV pressures, gradients, etc.
❌ 6. Modifier errors
Fix: Use -26 when billing professional-only in hospitals.
ICD-10 Codes Commonly Used With CPT 93458
Some of the most relevant include:
- I20.0 – Unstable angina
- I21.4 – NSTEMI
- I21.3 – STEMI
- I25.10 – Coronary artery disease
- R07.9 – Chest pain
- R06.02 – Shortness of breath
- I50.9 – Heart failure
- R94.39 – Abnormal cardiovascular testing
- Z01.810 – Pre-op cardiovascular exam
- I42.0 – Dilated cardiomyopathy
- Z95.1 – History of CABG
Final Thoughts
CPT 93458 is one of the most important — and most heavily scrutinized — cardiology billing codes. Correct usage requires clear documentation of medical necessity, precise anatomical interpretation, and accurate reporting of both the LHC and coronary angiography components. Ensure proper billing for in-clinic device evaluations using our CPT 93287 ICD/CRT-D In-Person Interrogation Billing Guide built to help cardiology teams maintain clean claims.
If your practice needs assistance reducing denials, managing cath lab documentation, or ensuring compliant coding, Global Tech Billing LLC offers specialized cardiology billing support to help your clinic get paid accurately and consistently.
Frequently Asked Questions (FAQ)
1. Can CPT 93458 be billed with PCI codes?
Yes — but only if the diagnostic cath was medically necessary and not performed solely to guide PCI.
2. Is LV ventriculography included?
Yes — it is included if performed.
3. Can you bill separately for ultrasound-guided access?
Yes — CPT 76937 may apply if properly documented.
4. Is moderate sedation included?
No — sedation may be billed separately when performed and documented.
Improve accuracy and avoid interrogation denials with our CPT 93286 Loop Recorder In-Person Interrogation Billing Guide including coding, device checks, and setup requirements.
5. Can a resident perform the procedure under supervision?
Yes — but billing requires supervision + attending documentation.
