CPT 93580 Transcatheter ASD Closure Reimbursement | OpenPayer

Summary & Overview

CPT 93580: Transcatheter Atrial Septal Defect Closure

CPT code 93580 represents a percutaneous transcatheter atrial septal defect (ASD) closure procedure in which an implant is delivered via catheter to seal an opening in the atrial septum. Nationally, this code captures an important, minimally invasive alternative to open surgical repair for congenital or iatrogenic atrial septal communications and is relevant for cardiac interventionalists, hospitals, and payers managing complex cardiovascular care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the common modifiers that may accompany claims. The publication also highlights benchmarking elements commonly reviewed by payers and providers (procedure utilization, site-of-service patterns, and coding nuances) and notes where input data is not provided.

This summary provides the groundwork to understand billing and administrative considerations tied to CPT code 93580, situating the code within cardiovascular service lines and hospital-based interventional care. Data not available in the input is flagged where relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 93580atrial septal defect closuretranscatheter closurecardiac catheterizationinterventional cardiologyhospital outpatientprocedure coding

Billing Code Overview

CPT code 93580 describes a percutaneous transcatheter procedure to close an opening in the atrial septum (an atrial septal defect or surgically created opening). The provider advances a catheter through a large vein in the groin into the right side of the heart, injects contrast dye, obtains imaging of the atrial chambers and ventricles, and deploys an implant to occlude the septal defect.

Service type: Percutaneous transcatheter atrial septal defect closure
Typical site of service: Hospital catheterization laboratory or specialized cardiac interventional suite

Clinical & Coding Specifications

Clinical Context

A 7-year-old child with a history of exertional dyspnea and recurrent right-sided cardiac murmurs is referred for transcatheter closure of an atrial septal defect (ASD). Prior transthoracic echocardiography documents a secundum-type ASD with right atrial and right ventricular enlargement. The interventional cardiology team schedules a catheter-based procedure under general anesthesia in a cardiac catheterization laboratory. A femoral venous access is obtained, a catheter is advanced to the right atrium, and contrast angiography and transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) are used to define the defect size and rims. Hemodynamic measurements and imaging guide selection and deployment of a septal occluder device. Post-deployment angiography and echocardiography confirm device position and absence of residual shunt or obstruction. The patient is monitored in a post-anesthesia care area and typically discharged same day or after an overnight observation with instructions for activity restriction and endocarditis prophylaxis guidance as indicated.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician interpretation/management component separate from technical services (rare for this code).
`52`

CPT 93581: Transcatheter Ventricular Septal Defect Closure

CPT-93582-TRANSCATHETER-PDA-CLOSURE

CPT 93582: Transcatheter Closure of Patent Ductus Arteriosus

Taxonomy Code	Specialty	Notes
208100000X	Pediatric Cardiology	Common specialty performing transcatheter ASD closure in children.
207RC0000X	Interventional Cardiology	Adult congenital and structural heart interventions are performed by interventional cardiologists.
207RP1001X	Cardiology	General cardiologists involved in diagnosis and peri-procedural management.
207L00000X	Cardiovascular Thoracic Surgery	Surgical specialists involved when surgical repair is considered or for hybrid procedures.
246Z00000X	Anesthesiology	Anesthesia providers for general anesthesia or monitored anesthesia care during the procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q21.1`	Atrial septal defect	Primary congenital diagnosis indicating an opening between atria that may require closure.
`Q21.0`	Ventricular septal defect	Related septal congenital defect; may prompt concurrent evaluation though not treated with this code.
`I35.0`	Nonrheumatic aortic (valve) stenosis	Example comorbidity that may affect procedural planning (hemodynamics).
`I48.91`	Unspecified atrial fibrillation	Arrhythmia that can be present pre- or post-procedure and influence monitoring.
`R06.02`	Shortness of breath	Symptom prompting evaluation leading to ASD diagnosis and closure consideration.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Pre-procedural evaluation code for pediatric patients undergoing elective repair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`93452`	Right and left heart catheterization including intraprocedural injection for left ventriculography, when performed	Hemodynamic assessment or left heart catheterization performed before or during structural interventions when indicated.
`93581`	Percutaneous transcatheter closure of intracardiac shunt with device, including imaging guidance when performed; with implantation of multiple devices or other complex techniques (example follow-on code)	Alternate or additional code used when multiple devices or additional complex closure techniques are required.
`93312`	Echocardiography, transesophageal, real-time with image documentation (2D)	Intra-procedural TEE guidance commonly used to size the defect and confirm device position during ASD closure.
`93662`	Intracardiac echocardiography during cardiac catheterization, including interpretation and report	ICE performed as intraprocedural imaging guidance for device placement instead of TEE.
`99223`	Initial hospital care, typically 70 minutes or more	High-complexity inpatient pre- and post-procedure evaluation for patients requiring admission after the procedure.

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