Summary & Overview

CPT 75573: Cardiac CT for Congenital Heart Evaluation

CPT code 75573 denotes a contrast-enhanced cardiac computed tomography (CT) examination targeted at evaluating congenital cardiac anomalies, including three-dimensional post-processing and assessment of left and right ventricular structure and function. This procedure is clinically significant for noninvasive anatomic and functional characterization of congenital heart disease, aiding surgical planning, longitudinal surveillance, and multidisciplinary care coordination. Nationally, cardiac CT for congenital conditions has grown as imaging technology and post-processing capabilities improve, increasing its role alongside echocardiography and cardiac MRI.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage considerations and billing context across major payers, common modifier usage, and clinical indications tied to the code. The publication summarizes typical service settings and operational implications for radiology and cardiology practices, and highlights benchmarks and policy updates relevant to use of contrast-enhanced cardiac CT in congenital heart disease. Where specific payer policy text or utilization data are not present in the input, the publication notes that such detailed data are not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare75573CPTcardiac CTcongenital heart diseasediagnostic imaging3D post-processingcardiologyradiologycontrast-enhanced CT

Billing Code Overview

CPT code 75573 describes a cardiac computed tomography (CT) study specifically performed to evaluate congenital cardiac anomalies. The procedure involves administration of intravenous contrast to delineate cardiac and vascular anatomy, permits assessment of left ventricular function, evaluation of right ventricular structure and function, and may include three-dimensional post-processing to better visualize complex congenital defects.

Service Type: Diagnostic cardiac CT with contrast for congenital heart disease evaluation

Typical Site of Service: Hospital outpatient radiology/imaging departments, outpatient imaging centers, and specialized cardiac CT labs

Clinical & Coding Specifications

Clinical Context

A 28-year-old patient with a known congenital heart defect (such as tetralogy of Fallot repair in childhood) presents for noninvasive anatomic and functional assessment due to progressive exertional dyspnea and a new right-sided murmur. The cardiology team orders a contrast-enhanced cardiac CT for congenital heart disease evaluation to define intracardiac and extracardiac anatomy, evaluate right and left ventricular size and function, and assess vascular structures and surgical conduits.

The clinical workflow begins with scheduling in an outpatient or ambulatory imaging center with advanced cardiac CT capability. Pre-procedure screening checks renal function, allergy history, and prior imaging. On the day of service the patient is registered, IV access is obtained, and contrast consent is confirmed. The CT technologist performs ECG-gated CT acquisition with contrast under a supervising radiologist or cardiothoracic imaging cardiologist. The interpreting physician performs three-dimensional post-processing and formal measurement of ventricular function, vascular anatomy, and any residual or recurrent congenital lesions. The final report includes multiplanar and 3D reconstructions and quantitative left ventricular function assessment when performed.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When reporting only the physician interpretation separate from technical imaging performed by the facility.

Taxonomy Code	Specialty	Notes
2084P0800X	Diagnostic Radiology	Radiologists commonly perform and interpret cardiac CT studies.
207RC0000X	Cardiovascular Disease	Cardiologists, particularly advanced imaging cardiologists, interpret and request congenital cardiac CTs.
2084N0402X	Thoracic Radiology	Subspecialty radiologists who focus on chest and cardiac imaging perform detailed cardiac CT interpretations.
208Z00000X	Emergency Medicine	Emergency physicians may order or interpret emergent cardiac CTs in acute presentations.
207L00000X	Pediatric Cardiology	Pediatric cardiologists manage congenital heart disease patients and often coordinate cardiac CT imaging.

CPT Code	Description	Relationship to This Procedure
`71250`	CT chest without contrast material, followed by contrast material(s) and further sections	May be used when additional noncardiac chest contrast-enhanced CT imaging is performed in conjunction with cardiac CT to evaluate thoracic vasculature.
`75571`	CT angiography, chest, with contrast, including non-contrast images if performed; image post-processing when performed	May be used for dedicated CT angiography of thoracic vasculature when broader vascular assessment is required alongside congenital heart CT.
`93750`	Ambulatory blood pressure monitoring, wearing device, recording and interpretation	Often ordered in the overall cardiac assessment workflow but not part of imaging billing; included when concurrent hemodynamic evaluation is documented.
`93306`	Echocardiography, transthoracic, real-time with image documentation, complete	Commonly performed before or after CT to evaluate valvular function and provide complementary functional data.
`76376`	3D rendering with interpretation and reporting of CT/angiography studies	Used when advanced three-dimensional post-processing and rendering are performed as part of the cardiac CT study.

OpenPayer