CurrentBlue Cross Blue Shield - NebraskaPolicy M.33

MA Cardiac Catheterization (Preauthorization Required)

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Preauthorization and medical necessity criteria for right, left, and combined cardiac catheterization procedures for BCBS Nebraska members; intended for providers requesting authorization.

Policy Summary

PayerBlue Cross Blue Shield - Nebraska

PolicyMA Cardiac Catheterization (Preauthorization Required)

Policy CodePolicy M.33

Change TypeNo material change

Effective DateMar 1, 2026

Last ReviewNov 7, 2024

Next Review DateNov 4, 202612d

Key ActionObtain preauthorization by submitting the procedure and diagnosis code pair for listed cardiac catheterization procedures.

SourceLink

≈40Codes listed

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CurrentBlue Cross Blue Shield - NebraskaPolicy M.33

MA Cardiac Catheterization (Preauthorization Required)

Customize your policy alerts

Sign up for Blue Cross Blue Shield - Nebraska Policy M.33 alerts

Get alerted when Policy M.33 changes without checking for updates manually.

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Preauthorization and medical necessity criteria for right, left, and combined cardiac catheterization procedures for BCBS Nebraska members; intended for providers requesting authorization.

Policy Summary

PayerBlue Cross Blue Shield - Nebraska

PolicyMA Cardiac Catheterization (Preauthorization Required)

Policy CodePolicy M.33

Change TypeNo material change

Effective DateMar 1, 2026

Last ReviewNov 7, 2024

Next Review DateNov 4, 202612d

Key ActionObtain preauthorization by submitting the procedure and diagnosis code pair for listed cardiac catheterization procedures.

SourceLink

≈40Codes listed

Indication categories

IncludedLegal notice

Coverage Criteria for Cardiac Catheterization

Right Heart Catheterization - Reasonable and Necessary

Right heart catheterization may be reasonable and necessary when ONE OR MORE of the following indications are present:

Known or suspected congenital heart disease: Direct measurement of cardiac chamber pressure or oxygen saturations are needed (e.g., determination of presence and extent of intracardiac shunt, pulmonary hypertension, valvular heart disease) OR an invasive cardiovascular procedure is planned (e.g., pulmonary valvuloplasty, pulmonary artery branch stenosis, and preoperative or postoperative catheterization or angiographic imaging needed) OR noninvasive imaging is nondiagnostic or there are conflicting findings on physical exam.one or more

Policy I.A (chunk 6)

Other named indications (each may independently justify RHC): Cor pulmonale; Endocarditis requiring valvular surgical repair; Pulmonary hypertension; Suspected cardiomyopathy or myocarditis; Suspected heart transplant rejection; Evaluation of heart failure; Heart failure newly diagnosed or with persistent or worsening symptoms despite treatment when hemodynamic information will guide further intervention; Evaluation of heart failure for preoperative planning before cardiac transplantation or mechanical circulatory support; Intracardiac or extracardiac shunts (including septal rupture); Suspected or known valvular disease when noninvasive tests are inconclusive, inconsistent, or discordant with symptoms or when valvular surgery/intervention is planned; Suspected pericardial tamponade or constrictive pericarditis.any single listed condition

Policy I.B–M (chunk 6)

Right Heart Catheterization - Not Reasonable and Necessary

Right heart catheterization is not reasonable and necessary when the above criteria are not met or for the following:

Not reasonable/necessary: Atherosclerotic heart disease without heart failure; Angioplasty, electrophysiologic studies, or other interventional procedures.any single condition

Policy II.A–B (chunk 6)

Left Heart Catheterization - Reasonable and Necessary

Left heart catheterization may be reasonable and necessary for diagnosis or treatment planning when ANY of the following are present:

Indications for left heart catheterization: Myocardial abnormalities or dysfunction (including ischemic disease, myocarditis, cardiomyopathy); Valvular dysfunction; Intracardiac shunts; Congenital heart abnormalities; Cardiac trauma; Pericardial tamponade.any single condition

Left Heart Catheterization I (chunk 7)

Combined Right and Left Catheterization

Right and left heart catheterization may be reasonable and necessary when:

Combined procedure indication: One disease process appears to affect both sides of the heart or a different disease process appears to affect each side of the heart.N/A

Right and Left Catheterization I (chunk 7)

In addition to the specific indications listed elsewhere in this policy, a right heart catheterization (RHC) is explicitly not reasonable and necessary when the criteria in Section I are not met. The policy specifically identifies RHC as not reasonable and necessary for atherosclerotic heart disease without heart failure and for procedures that are primarily interventional in nature such as angioplasty, electrophysiologic studies, or other interventional procedures.

This policy does not attempt to enumerate every possible exclusion or administrative exception. The document and references linked in the policy provide general administrative and legal notices, and absence of a named exclusion in the policy text does not imply automatic coverage. Providers should refer to applicable benefit contracts and the Medical Policy Disclaimer for situations not explicitly listed.

If the clinical presentation does not meet one or more of the indications described for right heart catheterization in Section I, the procedure is considered not reasonable and necessary. Authorization decisions require documentation that the member’s condition meets the stated indications (for example, congenital heart disease with need for direct pressure/oxygen measurements, pulmonary hypertension, evaluation of heart failure where hemodynamic data will influence management, etc.).

Refer to the Coding section for the complete list of procedure and add‑on codes that require preauthorization. Examples shown in the policy include covered primary and add‑on CPT codes such as 93462 (left heart catheterization by transseptal puncture) and 93505 (endomyocardial biopsy), and numerous injection and congenital catheterization codes. Preauthorization and medical necessity determinations require submission of both the procedure code and an appropriate diagnosis to demonstrate that the written indications are met.

When evaluating requests, reviewers will reaffirm the clinical criteria described for right and left heart catheterization. If documentation does not support one of the listed indications (for example, absence of heart failure or pulmonary hypertension when these are the stated reasons for RHC), the procedure may be denied as not reasonable and necessary.

CPT / Procedure Codes

Covered CPT Codes (listed in policy)CPTCovered

93451	RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
93452	L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
93453	R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
93454	CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I
93455	CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
93456	CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
93457	CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I
93458	CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
93459	CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
93460	R & L HRT CATH WINJX HRT ART& L VENTR IMG

1–10 of 22

1/3

Add-on and injection procedure codesCPTCovered

93462	LEFT HEART CATH BY TRANSEPTAL PUNCTURE
93505	ENDOMYOCARDIAL BIOPSY
93563	NJX DRG CGEN C-CATHJ SLCTV CORONARY ANGRPH S&I
93564	NJX DRG CGEN C-CATHJ SLCTV OPACIFICATION S&I
93565	NJX DRG C-CATHJ SLCTV L VNTRC/L ATRIAL ANGRPHS&I

Congenital heart catheterization and additional proceduresCPTCovered

93566	Injection procedure for selective right ventricular or right atrial angiography (imaging supervision/interpretation)
93567	Injection procedure for supravalvular aortography (imaging supervision/interpretation)
93568	Injection procedure for nonselective pulmonary arterial angiography (imaging supervision/interpretation)
93593	Right heart catheterization for congenital heart defect(s) with imaging guidance to advance catheter to target zone; normal native connections
93594	Right heart catheterization for congenital heart defect(s) with imaging guidance; abnormal native connections
93595	Left heart catheterization for congenital heart defect(s) with imaging guidance to target zone
93596	Right and left heart catheterization for congenital heart defect(s) with imaging guidance; normal native connections
93597	Right and left heart catheterization for congenital heart defect(s) with imaging guidance; abnormal native connections
93598	Cardiac output measurement(s), thermodilution or other indicator dilution method, performed during cardiac catheterization for evaluation of congenital heart defects

Provider Actions, Prior Authorization, and Billing Rules

Prior Authorization

Prior authorization required for listed cardiac catheterization procedures

Preauthorization is required for cardiac catheterization procedures listed in this policy; providers must submit the procedure and diagnosis code pair for review.

Submit both the procedure code and the associated diagnosis code as a code pair when requesting preauthorization.

Prior Authorization

Include listed add-on and injection procedure codes in preauthorization

Preauthorization is required for the catheterization procedures and the listed add-on injection/monitoring procedure codes; these add-on codes must be included in the request when applicable.

Include add-on/injection codes (for example 93462, 93505, 93563–93565) on the authorization request when those services will be performed.

Background

Cardiac catheterization is a minimally invasive diagnostic and therapeutic procedure used to measure intracardiac pressures, obtain angiographic imaging, and perform interventions where indicated. Right heart catheterization accesses the venous circulation to evaluate right‑sided pressures, pulmonary vascular resistance, oxygen saturations and shunt assessment; typical indications include congenital heart disease assessment, pulmonary hypertension evaluation, heart failure assessment when hemodynamic data will guide management, suspected cardiomyopathy or myocarditis, and suspected pericardial tamponade or constrictive pericarditis. Left heart catheterization accesses the arterial circulation for left ventricular assessment and coronary angiography and may be performed when ischemic disease, valvular dysfunction, intracardiac shunts, congenital abnormalities, cardiac trauma, or pericardial tamponade are suspected.

These procedures require appropriate coding and preauthorization per the policy. The Medical Policy Disclaimer clarifies that policy statements are used to administer plan benefits and do not themselves constitute authorization or a contract for benefits.

Definitions and Procedure Descriptions

Right heart catheterization — definition

DefinitionRight heart catheterization: catheter inserted into a vein (arm, groin, or neck) and guided to the right-sided heart chambers (right atrium, right ventricle) and the pulmonary artery to measure intracardiac pressures and blood oxygen saturations and to obtain angiographic images.

Primary measurementsChamber pressures and blood oxygen saturations (including pulmonary artery pressures).

ImagingAngiogram images of the right ventricle and pulmonary artery may be obtained during the procedure.

Common indicationsDiagnostic evaluation of congenital heart disease, dyspnea, heart failure, pericardial disease, pulmonary hypertension, valvular heart disease, shock/hypotension, and volume status assessment in renal failure.

Left heart catheterization — definition

Definition

Policy Revision History

2026-03-01policy_effectiveLatest

Policy effective date updated to March 1, 2026; preauthorization required for listed cardiac catheterization procedures remains in place.

2024-11-07last_review

Last clinical review completed on November 7, 2024.

Policy Summary

PayerBlue Cross Blue Shield - Nebraska

PolicyMA Cardiac Catheterization (Preauthorization Required)

Policy CodePolicy M.33

Change TypeNo material change

Effective DateMar 1, 2026

Last ReviewNov 7, 2024

Next Review DateNov 4, 202612d

Key ActionObtain preauthorization by submitting the procedure and diagnosis code pair for listed cardiac catheterization procedures.

SourceLink

On This Page

Note

No additional actionable items listed in this segment

No additional explicit provider actions are listed in this segment beyond preauthorization, code-pair submission, and inclusion of add-on codes; providers should follow the policy's preauthorization instructions.

Use the policy Quick Code Search to verify whether a procedure and diagnosis code pair will be approved, denied, or held for review.

Documentation Required

Policy administrative guidance — policies do not guarantee authorization

The policy includes administrative guidance about use of Medical Policies and the provider’s responsibility to obtain required preauthorization; these policies do not themselves guarantee authorization or constitute a contract.

Providers remain responsible for obtaining plan-required preauthorization as indicated by the policy.

Documentation Required

Submit procedure + diagnosis code pair for authorization

Procedure and diagnosis code pairs are required for quick code search and for preauthorization determination; both a procedure code and a diagnosis code must be provided.

Enter the procedure code first, then the diagnosis code, then click 'Add Code Pair' when using the Quick Code Search tool.

Documentation Required

Administrative note — policies are not authorization or a contract

Medical Policies are used in administering plan benefits and do not constitute authorization, certification, or a contract for benefits; benefits are determined by the applicable benefit contract.

These policies are subject to change; the Medical Policy Committee reviews and updates policies periodically.

Denial Risk

Denial risk if RHC criteria not met or for ASHD without heart failure

Right heart catheterization is not reasonable and necessary if the policy criteria are not met or for atherosclerotic heart disease without heart failure; angioplasty, electrophysiologic studies, or other interventional procedures are also listed as noncovered indications.

If submitted indications do not meet the policy’s listed criteria, the request may be denied as not reasonable and necessary.
Requests solely for angioplasty, electrophysiologic studies, or other interventional procedures without meeting indications may be denied.

Note

Provider summary — follow preauthorization and documentation requirements

This segment does not enumerate additional explicit denial trigger details beyond the above RHC criteria; providers must follow the policy’s preauthorization requirement and submit required code pairs and indications for review.

Absence of explicit triggers in this segment does not remove the requirement to submit appropriate documentation and code pairs for review.

Left heart catheterization: catheter inserted into an artery (arm, groin, or wrist) and guided to the left ventricle to measure left ventricular pressures or to obtain an angiogram (left ventriculography).

Primary measurementsLeft ventricular pressures and ventriculographic assessment of left ventricular function and valvular disease.

Common useMost commonly performed with coronary angiography to assess left ventricular pressure, function, and valvular heart disease.

Access sitesArterial access via arm, groin, or wrist.

CPT 93462 — transseptal left heart catheterization

CodeCPT 93462 — Left heart catheterization by transseptal puncture.

DescriptionLeft heart catheterization by transseptal puncture through intact septum or by transapical puncture.

Billing noteListed separately in addition to the code for the primary procedure.

CPT 93505 — endomyocardial biopsy

CodeCPT 93505 — Endomyocardial biopsy.

DescriptionEndomyocardial biopsy performed during cardiac catheterization.

Billing noteListed as a distinct procedure in the policy coding section; submit code for prior authorization when performed.

CPT 93565 — injection for selective LV or LA angiography (add-on)

CodeCPT 93565 — Injection procedure for selective left ventricular or left atrial angiography (add-on).

DescriptionInjection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective left ventricular or left atrial angiography (listed separately in addition to the primary procedure).

Billing noteThis is an add-on/injection code and should be reported in addition to the primary catheterization code when performed.