CPT code 93597: Combined heart cath, abnormal native connections2026 Medicare rate & RVUs in Texas
Reports diagnostic right- and left-heart catheterization for congenital heart disease when native cardiovascular connections are abnormal, typically in a cardiac catheterization laboratory.
CMS doesn’t publish an office rate for 93597 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 93597 covers
This diagnostic catheterization evaluates congenital heart disease when the patient’s native cardiovascular connections are abnormal. A cardiologist performs both right- and left-heart catheterization to assess pressures and hemodynamics in relation to the congenital anatomy. The service is typically performed in a hospital cardiac catheterization laboratory by a cardiologist experienced in congenital heart disease. It describes diagnostic catheterization, rather than a transcatheter defect-closure procedure.
Medicare assigns status C: CMS publishes no national payment, and the Medicare Administrative Contractor sets payment for each claim. Modifier 26 identifies the professional interpretation, modifier TC identifies the technical service, and billing without either modifier represents the global service. The code has a 0-day global period, with same-day preoperative and postoperative care included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment does not apply; assistant-at-surgery payment requires documented medical necessity, and co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 93597 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | Unavailable |
| Beaumont, TX | Unavailable | Unavailable |
| Brazoria, TX | Unavailable | Unavailable |
| Dallas, TX | Unavailable | Unavailable |
| Fort Worth, TX | Unavailable | Unavailable |
| Galveston, TX | Unavailable | Unavailable |
| Houston, TX | Unavailable | Unavailable |
| Rest of Texas | Unavailable | Unavailable |
How the 93597 rate is calculated
Each of 93597’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 93597
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 93597
The CMS indicators that decide how 93597 is paid alongside other services.
CMS payment indicators · 93597
Combined heart cath, abnormal native connections
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
93597 without 26 · national facility
$0.00
Combined heart cath, abnormal native connections
93597-26 · Professional component
$409.16
Pays only the interpretation and report.
93597 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 93596Right and left cathNormal native connections
- Both codes describe combined right- and left-heart catheterization. Choose 93597 for abnormal native connections and 93596 for normal native connections.
- 93594Right-heart catheterizationAbnormal native connections
- 93594 describes right-heart catheterization alone for abnormal native connections; 93597 describes both right- and left-heart catheterization for that anatomy.
- 93595Left heart cathCongenital heart disease
- 93595 describes left-heart catheterization for congenital disease. 93597 represents combined right- and left-heart catheterization when native connections are abnormal.
93597 billing questions
When should 93597 be chosen over 93596?
Use 93597 for combined right- and left-heart catheterization in congenital heart disease with abnormal native connections. Code 93596 describes the combined catheterization when native connections are normal.
How does 93597 differ from 93594?
93597 represents both right- and left-heart catheterization for abnormal native connections. 93594 represents right-heart catheterization alone for that congenital anatomy.
Can the professional and technical services be reported separately?
Yes. Modifier 26 identifies the professional interpretation and modifier TC identifies the technical service; without either modifier, the claim represents the global service.
What documentation supports reporting 93597?
Document the congenital heart disease and abnormal native connections, and show that both right- and left-heart catheterization were performed.
How does Medicare price 93597?
Status C means CMS publishes no national payment. The Medicare Administrative Contractor sets payment for each claim.
Does modifier 50 apply to 93597?
No. Medicare’s bilateral adjustment does not apply to this code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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