CPT 93461: Right and Left Heart Catheterization with Coronary and Bypass Graft Imaging
Medicare pays $919 and commercial payers pay $3380 on average nationally for this procedure.
CPT code 93461 describes combined right and left heart catheterization with coronary and bypass graft imaging to evaluate cardiac function and coronary anatomy; this is an invasive diagnostic cardiovascular procedure typically performed by interventional cardiology or cardiovascular specialists in an inpatient or hospital-based outpatient catheterization laboratory (cardiac cath lab) setting.
For related coverage guidance, see recent payer policy updates: Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA), Cardiovascular Disease Risk Assessment, Biomarkers for Myocardial Infarction and Chronic Heart Failure.
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National Reimbursement Benchmarks
National mean rates show Medicare at $918.8 versus BUCA’s average commercial mean of $3,379.7, indicating BUCA pays roughly $2,460.9 more on average than Medicare for CPT 93461. This gap highlights a meaningful split between the federal program and higher-paying commercial contracts; other commercial payers (Aetna, Blue Cross Blue Shield, Cigna, UnitedHealth Group) cluster between those endpoints with variable central tendency measures.
Dispersion measured by the interquartile range (P75–P25) is widest for Blue Cross Blue Shield at $4,861.3 and narrowest for Aetna at $808.5. UnitedHealth Group and Cigna show similar mid-to-high dispersion ($1,179.0 and $1,159.6 respectively), while BUCA’s IQR is $3,246.1 and Medicare’s IQR is $868.0, placing Medicare among the tighter distributions despite its lower mean.