Summary & Overview
HCPCS C7526: Coronary Angiography with Left Heart Catheterization and Flow Measurement
HCPCS Level II code C7526 represents an advanced coronary angiography procedure that bundles catheter placement in coronary arteries and bypass grafts, imaging supervision and interpretation, left heart catheterization with possible left ventriculography, and intravascular physiologic measurements such as Doppler velocity or pressure-derived coronary flow reserve during pharmacologic stress. Nationally, this code captures complex diagnostic and physiologic assessment workflows critical to ischemic heart disease evaluation and revascularization planning. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical components represented by the code, typical settings where the service is delivered, and the payer mix considered. The publication summarizes available benchmarks and billing considerations at a national level, outlines clinical context for when this bundled angiography and physiologic assessment is performed, and notes areas where policy or coverage guidance may affect reimbursement workflows. Data not available in the input is identified where applicable, and the piece is intended as an informational resource on the code’s scope and relevance rather than guidance on clinical care or billing decisions.
Billing Code Overview
HCPCS Level II code C7526 describes catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed. The code also includes catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography and intravascular Doppler velocity and/or pressure-derived coronary flow reserve measurement (initial coronary vessel or graft) during coronary angiography, including pharmacologically induced stress.
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Service type: Diagnostic and interventional coronary angiography with left heart catheterization and physiologic flow assessment, including imaging supervision and interpretation
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Typical site of service: Hospital inpatient or outpatient cardiac catheterization laboratory; may also be performed in ambulatory surgical centers equipped for invasive cardiac procedures
Clinical & Coding Specifications
Clinical Context
A 67-year-old male with a history of hypertension, hyperlipidemia, and prior coronary artery bypass grafting presents to the emergency department with exertional chest pain and new ischemic changes on ECG. Noninvasive testing is equivocal for ischemia. The interventional cardiology team schedules a diagnostic coronary angiography with left heart catheterization and coronary flow reserve measurement to assess native coronary arteries and bypass grafts.
Procedure workflow: the patient is prepped in a cardiac catheterization laboratory. Conscious sedation or monitored anesthesia care is provided based on anesthesiology evaluation. Vascular access is obtained (typically femoral or radial). Selective catheterization of coronary ostia is performed with intraprocedural contrast injections for coronary angiography. Left heart catheterization is performed with left ventriculography when indicated. Catheterization of bypass grafts (internal mammary, saphenous vein or arterial grafts) is performed with graft angiography. Intravascular Doppler velocity and/or pressure-derived coronary flow reserve (CFR) measurements are performed in the initial coronary vessel or graft during pharmacologic stress when clinically indicated. Imaging supervision and interpretation are documented by the attending interventional cardiologist, procedural findings recorded, and post-procedure hemostasis and recovery arranged in the cath lab recovery area or same-day observation unit.
Typical site of service: hospital outpatient department (cardiac catheterization laboratory) or inpatient cardiac catheterization lab when performed during an admission.
Coding Specifications
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