Combined right and left heart catheterization plays a critical role in the evaluation of complex cardiovascular disease. When both chambers are assessed in one encounter, and coronary angiography is performed, the correct CPT code is 93460. This is one of the most comprehensive diagnostic cardiac cath codes, commonly used in patients with heart failure, valvular disease, pulmonary hypertension, cardiomyopathy, and suspected coronary artery disease.
Because of the high complexity and high reimbursement associated with CPT 93460, payers closely scrutinize claims. Proper documentation, correct coding, and an understanding of what is — and isn’t — included are essential to avoid denials. Strengthen your remote device monitoring workflows using our detailed CPT 93272 Pacemaker & ICD Remote Monitoring Billing Guide covering documentation, technical components, and payer rules.
This complete guide covers everything cardiology practices need to know about billing CPT 93460 accurately, including medical necessity, bundling rules, prior authorization, documentation requirements, reimbursement expectations, common denials, ICD-10 pairing, and FAQs.
What Is CPT 93460?
Official CPT description:
“Combined right and left heart catheterization including intraprocedural injections for left ventriculography, imaging supervision and interpretation, with coronary angiography.”
In clinical terms:
CPT 93460 = Right heart cath (RHC) + Left heart cath (LHC) + Coronary angiography.
All performed in the same session.
This code reflects a full hemodynamic and anatomical evaluation — pressures, oxygen saturations, ventriculography (if performed), and visualization of the coronary arteries.
What CPT 93460 Includes
To bill 93460 correctly, the following services must be completed in the same encounter:
1. Right Heart Catheterization (RHC)
Includes:
- Venous access
- Catheter placement into the right atrium, right ventricle, and pulmonary artery
- Pulmonary artery wedge pressure (PAWP)
- Measurement of:
- RA pressure
- RV pressure
- PA pressure
- PAWP
- Cardiac output/index
- Oxygen saturation sampling
2. Left Heart Catheterization (LHC)
Includes:
- Arterial access
- Advancement of the catheter into the LV
- LV pressure measurements
- LVEDP measurement
- Pullback pressure gradient
3. Coronary Angiography
Includes:
- Selective catheter placement in the coronary arteries
- Injection of contrast
- Imaging and documentation of the right and left coronary systems
- Interpretation and reporting
4. Left Ventriculography (When Performed)
If the provider performs an LV gram, it is included — not separately billable. 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. Imaging Supervision and Interpretation
Physicians must:
- Supervise contrast injection
- Interpret coronary anatomy
- Document lesions (location, severity, appearance)
- Describe ventricular function (if LV gram performed)
- Provide a formal report
What CPT 93460 Does NOT Include
Certain additional services require separate codes.
Not included (bill separately when performed):
Bypass Graft Angiography
Use add-on code 93461 (RHC + LHC + coronary angiography + bypass graft).
Instantaneous wave-free ratio (iFR) or Fractional Flow Reserve (FFR)
- 93571 (first vessel)
- 93572 (each additional vessel)
Intravascular ultrasound (IVUS)
- 92978 (initial vessel)
- 92979 (additional vessels)
Optical coherence tomography (OCT)
- 92978/92979, depending on the payer
PCI procedures
- 92920, 92924, 92928, etc.
Ultrasound-guided vascular access
- 76937, if documented correctly
Moderate sedation
- 99152–99153 (often billable)
When to Use CPT 93460
Bill CPT 93460 when all of the following are true:
- The provider performs both RHC + LHC
- Coronary angiography is performed during the same session
- A full hemodynamic assessment is needed
- The study is diagnostic (not purely pre-planned for PCI)
Clinical scenarios where 93460 is appropriate:
Heart failure evaluation
- Suspected cardiomyopathy
- Pre-transplant workup
- Pulmonary hypertension evaluation
Coronary artery disease evaluation
- Unstable angina
- Abnormal stress test
- Elevated troponin in stable patients
- Suspected multi-vessel disease
Valvular heart disease evaluation
- Aortic stenosis gradient measurement
- Mitral regurgitation with LV dysfunction
- Pre-surgical evaluation for valve replacement
Unexplained dyspnea or syncope
Diagnostic workup requiring combined hemodynamics + coronary evaluation. 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.
When NOT to Use CPT 93460
Do not use 93460 if:
❌ Only an RHC was done
→ bill 93451
❌ Only an LHC + coronary angiography was done
→ bill 93458
❌ Bypass graft angiography was performed
→ bill 93461
❌ Only pulmonary pressures were measured without LHC
→ bill 93451
❌ Cath was performed solely to guide a pre-planned PCI**
In this case, the diagnostic cath may not be separately billable unless medical necessity is clearly documented.
Medical Necessity Requirements
Payers want clear justification for combined right and left heart catheterization.
Common indications include:
Coronary artery disease
- Chest pain
- Abnormal nuclear or echo stress test
- Positive coronary CT angiography
- Troponin elevation
Heart failure
- New diagnosis
- Decompensated HF
- Differentiating ischemic vs non-ischemic cardiomyopathy
- Pre-LVAD evaluation
Pulmonary hypertension
- Confirming diagnosis
- Measuring vasoreactivity
- Differentiating pre- vs post-capillary PH
Valvular disease
- Aortic stenosis gradient evaluation
- Mitral regurgitation workup
Congenital heart disease
- Hemodynamic and shunt assessment
Pre-operative cardiovascular evaluation
For cardiac or thoracic surgeries where full hemodynamics are needed.
Master documentation and payer rules with our comprehensive CPT 93458 Left Heart Catheterization & Coronary Angiography Billing Guide optimized for interventional cardiology practices.
Documentation Requirements for CPT 93460
To avoid denials, your documentation must clearly include:
1. Indication for Procedure
What symptoms or testing led to invasive evaluation?
- Chest pain
- Dyspnea
- Abnormal test results
- Heart failure symptoms
2. Procedural Details
Must include:
- Access sites
- Catheters used
- Coronary arteries cannulated
- Hemodynamic tracings
- LVEDP
- PA, PAWP, RV, RA pressures
- Cardiac output/index
3. Imaging Interpretation
Document:
- Coronary anatomy
- Stenosis severity (in %)
- Location of lesions
- Coronary dominance
- LV function (if performed)
- Valvular gradient results
4. Post-Procedure Care
- Complications (none or specified)
- Hemostasis method
- Follow-up plans
5. Physician Signature
Digital or handwritten.
Prior Authorization Requirements
Because this is a high-cost procedure, PA requirements are strict.
Medicare
- Does not require PA
- Must have a strong medical necessity
Medicare Advantage
- Almost always requires a PA
- Exceptions for emergent cases
Commercial Insurance
Requires prior authorization for:
- Stable angina
- Elective diagnostic cath
- Valvular evaluations
- Non-emergent CAD assessment
Medicaid
Frequently requires a PA unless an emergency.
Emergency Cases
STEMI, cardiogenic shock, acute decompensated HF
→ PA not required, but documentation must show immediate need.
Reimbursement for CPT 93460
Approximate Medicare national averages:
- Facility component: ~$550–$750
- Professional component: ~$190–$260
Commercial reimbursement can be substantially higher, depending on your payer contracts.
Common Denials for CPT 93460
❌ 1. Missing or unclear medical necessity
Include symptoms + abnormal tests + decision-making.
❌ 2. Mis-coding RHC/LHC combinations
Ensure correct use of 93451, 93458, or 93461 when appropriate.
❌ 3. Lack of hemodynamic documentation
Missing PAWP or LVEDP leads to denials.
❌ 4. Missing coronary interpretation
A formal angiography interpretation is mandatory.
❌ 5. Diagnostic cath not justified before PCI
Document why diagnostic imaging was needed.
❌ 6. Incorrect modifier usage
Use -26 when billing professional-only in a hospital.
ICD-10 Codes Commonly Billed With CPT 93460
- I20.0 – Unstable angina
- I21.4 – NSTEMI
- I50.9 – Heart failure
- I25.10 – Coronary artery disease
- I27.20 – Pulmonary hypertension
- R07.9 – Chest pain
- R06.02 – Shortness of breath
- R94.39 – Abnormal cardiovascular test
- I35.0 – Aortic stenosis
- I42.0 – Cardiomyopathy
Final Thoughts
CPT 93460 represents one of the most complete diagnostic cardiac catheterization services, combining right heart hemodynamic assessment, left heart pressure evaluation, and coronary angiography. With higher reimbursement comes increased payer scrutiny, making precise documentation essential. 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.
If your cardiology practice needs help reducing denials, optimizing documentation templates, or improving cath lab billing workflows, Global Tech Billing LLC provides specialized cardiology billing support designed to increase reimbursement accuracy and protect compliance.
Frequently Asked Questions (FAQ)
1. Can CPT 93460 be billed with PCI codes?
Yes — if medical necessity for diagnostic cath is documented and not solely performed to guide PCI.
2. Is LV ventriculography required?
Not required — but if performed, it is included.
3. Can the RHC and LHC be billed separately?
No — if coronary angiography is also performed, 93460 is the correct comprehensive code.
4. Do we bill separately for ultrasound-guided access?
Yes — CPT 76937 may apply with proper documentation.
5. Does 93460 include sedation?
No — moderate sedation may be billable separately.
