Summary & Overview
CPT 92920: Percutaneous Coronary Intervention, Single Artery
CPT code 92920 is a nationally recognized billing code for percutaneous transluminal coronary intervention, targeting a single major coronary artery or its branches. This procedure is central to interventional cardiology, providing minimally invasive treatment for patients with coronary artery disease. The code is widely utilized in hospital outpatient departments and ambulatory surgery centers, reflecting its importance in acute cardiac care.
Major payers covering this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication offers a comprehensive overview of payer coverage, clinical benchmarks, and policy updates relevant to 92920. Readers will gain insight into the clinical context of the procedure, typical sites of service, and how this code fits within broader cardiovascular care pathways. The summary also highlights related codes and common modifiers, supporting accurate billing and compliance.
This article is designed for healthcare professionals, administrators, and policy analysts seeking up-to-date information on coding, reimbursement, and clinical application of percutaneous coronary interventions. It provides a clear understanding of the national landscape for 92920, including payer coverage and regulatory considerations.
CPT Code Overview
CPT code 92920 describes a percutaneous transluminal coronary intervention performed on a single major coronary artery and/or its branch(es). This procedure is a key component of interventional cardiology, typically conducted in a hospital outpatient setting (POS 22) or an ambulatory surgery center (POS 24). The code is used to report minimally invasive treatment of coronary artery disease, where a catheter is inserted to restore blood flow in blocked or narrowed arteries. This intervention is critical for patients experiencing acute coronary syndromes or other significant cardiac events, offering a less invasive alternative to open-heart surgery.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to the hospital outpatient department or ambulatory surgery center with symptoms suggestive of acute coronary syndrome, such as chest pain or shortness of breath. The patient may have a history of unstable angina or myocardial infarction. After diagnostic evaluation, the interventional cardiologist determines that percutaneous transluminal coronary angioplasty is indicated to treat a significant stenosis in a single major coronary artery or its branch. The procedure is performed using catheter-based techniques to restore blood flow, often as part of emergency or urgent care for acute coronary events.
Coding Specifications
- Modifier
63: Used when the procedure is performed on infants weighing less than 4 kg. This modifier indicates the increased complexity and risk associated with performing the procedure on very small patients.
| Provider Taxonomy Code | Specialty Name |
|---|---|
207RC0000X | Cardiovascular Disease Physician |
207RI0011X | Interventional Cardiology Physician |
207RG0300X | Geriatric Medicine Physician |
- Cardiovascular Disease Physician: Specializes in diagnosing and treating heart conditions.
- Interventional Cardiology Physician: Focuses on catheter-based treatments for heart disease.
- Geriatric Medicine Physician: Manages cardiovascular care in elderly patients.
Related Diagnoses
I20.0– Unstable angina: Indicates acute chest pain due to insufficient blood flow, often leading to angioplasty.I20.1– Angina pectoris with documented spasm: Represents chest pain caused by coronary artery spasm, which may require intervention.I20.81– Angina pectoris with coronary microvascular dysfunction: Refers to angina from small vessel disease, sometimes treated with angioplasty.I20.89– Other forms of angina pectoris: Covers less common angina types, potentially managed with angioplasty.I20.9– Angina pectoris, unspecified: General diagnosis for chest pain, often leading to coronary intervention.I21.01– ST elevation (STEMI) myocardial infarction involving left main coronary artery: Acute heart attack requiring urgent angioplasty.I21.02– ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery: Indicates a heart attack in a major artery, often treated with angioplasty.I21.09– ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall: Represents acute infarction in other anterior arteries, managed with angioplasty.I21.11– ST elevation (STEMI) myocardial infarction involving right coronary artery: Acute infarction in the right coronary artery, typically treated with angioplasty.I21.19– ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall: Refers to infarction in inferior wall arteries, managed with angioplasty.I21.21– ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery: Indicates infarction in the left circumflex, often requiring angioplasty.I21.29– ST elevation (STEMI) myocardial infarction involving other sites: Covers STEMI in other coronary sites, treated with angioplasty.I21.3– ST elevation (STEMI) myocardial infarction of unspecified site: General STEMI diagnosis, typically managed with angioplasty.I21.4– Non‑ST elevation (NSTEMI) myocardial infarction: Represents a heart attack without ST elevation, often treated with angioplasty.I21.9– Acute myocardial infarction, unspecified: General heart attack diagnosis, may require angioplasty.I21.A1– Myocardial infarction type 2: Indicates infarction due to supply-demand mismatch, sometimes managed with angioplasty.I21.A9– Other myocardial infarction type: Covers other types of infarction, potentially treated with angioplasty.
Related CPT Codes
| CPT Code | Description |
|---|---|
92924 | Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed, single major coronary artery and/or its branch(es) |
92928 | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed, single major coronary artery and/or its branch(es) |
92924may be used when atherectomy (removal of plaque) is performed in addition to angioplasty, often for more complex lesions.92928is used when a stent is placed during angioplasty to maintain vessel patency.- These codes are commonly used as alternatives or in conjunction with
92920, depending on the clinical scenario and procedural requirements.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 92920 is $387.64, which is significantly lower than the BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna) commercial average of $755.40. Commercial payers consistently reimburse at higher rates, with UnitedHealth Group and Cigna both exceeding $900 on average.
Rate dispersion varies notably across payers. Medicare exhibits the tightest range, with a difference of only $30.00 between its 75th and 25th percentiles, indicating minimal variation in reimbursement. In contrast, UnitedHealth Group and Cigna show the widest dispersion, with ranges of $520.50 and $477.40 respectively, reflecting greater variability in commercial payment rates. The table and chart below present the full breakdown of national benchmarks for each payer.
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