Summary & Overview
CPT 93564: Coronary Angiography for Congenital Heart Disease
CPT code 93564 represents a diagnostic invasive coronary angiography specifically performed for patients with congenital heart disease. The procedure involves catheter insertion into native coronary arteries and any bypass grafts, contrast injection, supervised image acquisition, image interpretation, and a formal report. As a focused angiographic evaluation in complex congenital anatomy, this code is used in tertiary care and hospital-based cardiac catheterization laboratories and has implications for resource use, facility scheduling, and specialist billing.
Key payers in this national overview include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of clinical context and typical site of service, plus guidance on what to expect in comparative benchmarks and policy considerations. The publication outlines common billing modifiers and coding relationships where available, summarizes payer coverage patterns, and highlights clinical scenarios that commonly prompt use of this code, such as evaluation of coronary artery anatomy or bypass graft assessment in congenital heart disease.
This summary is intended for billing managers, clinicians, and policy analysts seeking a concise reference to CPT code 93564, its clinical use, and the payer landscape nationally. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 93564 describes a diagnostic coronary angiography performed in a patient with congenital heart disease. In this procedure the provider passes a catheter into the coronary arteries, injects contrast dye, supervises and records image acquisition, interprets the images, and issues a report of findings. The procedure includes catheterization of native coronary arteries and any bypass grafts.
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Service type: Diagnostic invasive coronary angiography for congenital heart disease
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Typical site of service: Hospital cardiac catheterization laboratory or specialized cardiac catheterization suite
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient with a history of repaired congenital heart disease (prior arterial switch operation for transposition of the great arteries) presents with exertional chest pain and an abnormal transthoracic echocardiogram showing new wall motion abnormalities. The cardiology team schedules a diagnostic coronary angiography to evaluate native coronary artery anatomy and any prior bypass grafts for ischemia, patency, or anatomic anomalies related to congenital repairs. Pre-procedure workflow includes informed consent, review of anticoagulation and renal function, and assessment for contrast allergy; the patient is brought to the cardiac catheterization laboratory (cath lab). The interventional cardiologist or pediatric/congenital cardiology specialist performs arterial access, advances a coronary catheter selectively into the coronary ostia and any bypass grafts, injects iodinated contrast while supervising cine image acquisition, interprets the angiographic images in real time, and dictates a formal report documenting anatomy, lesions, graft status, and hemodynamic findings. Post-procedure workflow includes sheath removal, vascular access site management, monitoring for complications, and documentation of procedure details including cath times, contrast volume, and interpretation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician interpretation and report separate from technical services (for example, when the hospital bills technical component). |