Summary & Overview
CPT 92928: Percutaneous Coronary Stent Placement with Angioplasty
CPT code 92928 is a critical billing code in cardiovascular care, representing the percutaneous transcatheter placement of intracoronary stents with angioplasty for a single major coronary artery or branch. This procedure is widely performed to address coronary artery disease, a leading cause of morbidity and mortality in the United States. The code is relevant for hospital outpatient departments and ambulatory surgical centers, reflecting its use in acute and elective settings.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, provide coverage for this procedure, underscoring its clinical and financial significance. The publication offers insights into payer coverage, policy updates, and clinical benchmarks for 92928, helping readers understand the landscape of reimbursement and utilization. It also contextualizes the procedure within interventional cardiology, highlighting its role in treating conditions such as atherosclerotic heart disease and acute myocardial infarction.
Readers will gain a comprehensive overview of the code’s clinical indications, associated diagnoses, and related billing codes, as well as updates on modifiers and taxonomy classifications. The summary provides a clear framework for understanding how 92928 fits into broader cardiovascular service lines and payer policies, supporting informed decision-making for stakeholders across the healthcare spectrum.
CPT Code Overview
CPT code 92928 describes the percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed, for a single major coronary artery or branch. This procedure is a cornerstone of interventional cardiology, used to treat patients with coronary artery disease by restoring blood flow through blocked or narrowed arteries. The typical site of service for this procedure includes hospital outpatient settings or ambulatory surgical centers (ASC), such as outpatient hospital (POS 19) or ASC (POS 24).
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to the hospital outpatient department or ambulatory surgical center with symptoms suggestive of coronary artery disease, such as chest pain or evidence of myocardial ischemia. Diagnostic evaluation confirms significant stenosis in a single major coronary artery or branch. The interventional cardiologist performs a percutaneous transcatheter placement of an intracoronary stent, often accompanied by coronary angioplasty, to restore blood flow. The procedure is indicated for conditions such as acute myocardial infarction, unstable angina, or chronic atherosclerotic heart disease. Post-procedure, the patient is monitored for complications and managed according to standard cardiovascular protocols.
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.
| Modifier Code | Description |
|---|---|
63 | Procedure performed on infants less than 4 kg |
- Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
207RC0000X | Cardiovascular Disease Physician |
207RI0011X | Interventional Cardiology Physician |
207RG0300X | Geriatric Medicine Physician |
These taxonomies represent the specialties typically involved in performing and managing percutaneous coronary interventions.
Related Diagnoses
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I25.10: Atherosclerotic heart disease of native coronary artery without angina pectoris- Indicates chronic coronary artery disease without symptoms; relevant for elective stent placement.
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I21.9: Acute myocardial infarction, unspecified- Represents acute heart attack; stent placement is a standard intervention to restore blood flow.
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I20.9: Angina pectoris, unspecified- Denotes chest pain due to myocardial ischemia; stenting may be performed to relieve symptoms.
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I25.119: Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris- Reflects chronic coronary artery disease with angina; stenting is indicated to improve symptoms and prevent events.
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I25.110: Atherosclerotic heart disease of native coronary artery with unstable angina pectoris- Indicates unstable angina, a high-risk scenario where urgent stent placement is often required.
Related CPT Codes
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92929: Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure)- Used when stenting is performed in additional branches beyond the primary vessel addressed by
92928. Commonly billed together when multiple vessels are treated.
- Used when stenting is performed in additional branches beyond the primary vessel addressed by
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92973: Percutaneous transluminal coronary thrombectomy, mechanical (add-on)- Used as an add-on when mechanical thrombectomy is performed during the stent placement procedure to remove thrombus.
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92974: Coronary brachytherapy (add-on)- Add-on code for intracoronary radiation therapy, typically used in cases of restenosis after stenting.
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92978: Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) (add-on)- Add-on code for imaging performed during the procedure to assess vessel anatomy and stent placement.
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92979: Endoluminal imaging of coronary vessel or graft using IVUS or OCT during diagnostic evaluation and/or therapeutic intervention (add-on)- Used for additional imaging during diagnostic or therapeutic interventions.
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93571: Intravascular Doppler velocity and/or pressure (fractional flow reserve or coronary flow reserve) (add-on)- Add-on code for hemodynamic assessment of coronary lesions during the procedure.
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93572: Intravascular Doppler velocity and/or pressure (FFR or CFR) (add-on)- Used for additional hemodynamic measurements during the intervention.
These codes are often used together with 92928 to reflect the complexity and additional services provided during percutaneous coronary interventions. 92929 is commonly paired when multiple vessels are treated, while the add-on codes document adjunctive imaging or therapeutic techniques.
National Reimbursement Benchmarks
Medicare's national mean rate for 92928 is $464.52, which is substantially lower than the BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna) average commercial mean rate of $862.37. Commercial payers consistently reimburse at higher levels compared to Medicare, with UnitedHealth Group and Cigna both exceeding $1,000 on average.
Rate dispersion varies across payers. Medicare has the tightest range between the 25th and 75th percentiles ($36.00), indicating minimal variation in payment rates. In contrast, Cigna and UnitedHealth Group show the widest dispersions ($531.00 and $578.00, respectively), reflecting greater variability in commercial reimbursement. The table and chart below present the full breakdown of national benchmarks for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.