Summary & Overview
CPT 93590: Percutaneous Mitral Valve Occlusion, First Device
Headline: New billing descriptor clarifies percutaneous mitral valve leak closure procedure
Lead: CPT code 93590 designates the percutaneous insertion of the first occlusion device to close a leak around the mitral valve. The code captures a specialized transcatheter intervention for mitral regurgitation related to paravalvular leaks or prosthetic valve leaks and is relevant for procedural coding, payer coverage determinations, and facility resource planning nationwide.
What the code represents and why it matters: CPT code 93590 identifies a high-cost, high-complexity transcatheter structural heart procedure used to seal mitral valve leaks. As transcatheter solutions expand, accurate capture of this specific code supports clinical registries, quality measurement, and appropriate payment for facilities and interventional teams.
Key payers covered: Analysis includes major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication summarizes clinical context for percutaneous mitral occlusion, typical sites of service, and practical coding considerations. It highlights benchmarking points for utilization and reimbursement (where available), common modifiers used with structural heart interventions, and policy considerations relevant to coverage and documentation requirements. The piece also outlines gaps where data was not supplied and flags areas for follow-up, including detailed payer-specific coverage criteria and associated diagnostic coding.
Billing Code Overview
CPT code 93590 describes percutaneous insertion of a first occlusion device to close a leak around the mitral valve (the valve between the left atrium and left ventricle). The procedure involves advancing a specially designed prosthetic occlusion device through a catheter inserted percutaneously via a small incision and positioning the device to seal regurgitant flow around a previously implanted prosthetic mitral valve or native annulus.
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Service type: Percutaneous transcatheter mitral valve occlusion (first occlusion device insertion)
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Typical site of service: Hospital inpatient or hospital outpatient catheterization laboratory or hybrid operating room
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 78-year-old patient with a history of ischemic cardiomyopathy and prior mitral valve replacement presents with progressive dyspnea, orthopnea, and signs of congestive heart failure. Echocardiography and transesophageal echocardiography identify a clinically significant paravalvular leak around the prosthetic mitral valve with evidence of hemolysis and worsening heart failure symptoms despite optimized medical therapy. The interventional cardiology team schedules a percutaneous transcatheter mitral paravalvular leak closure. Under conscious sedation or general anesthesia in a cardiac catheterization laboratory or hybrid operating room, the operator obtains venous and arterial access, performs intracardiac and transesophageal imaging guidance, crosses the leak with specialized catheters and wires, and deploys the first occlusion device to seal the defect. Post-deployment angiography and echocardiography confirm device position and residual regurgitation. The patient is monitored in a post-anesthesia care unit or cardiac critical care unit and discharged per recovery and imaging results, with follow-up echo to assess durable closure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no specific modifier applies |
62 |