CPT 92941 Billing: PCI for Acute MI

CPT 92941 covers revascularization of an acute total or subtotal occlusion during an acute myocardial infarction. It pays more than elective PCI because it reflects the emergent setting, and its denials turn on whether the record actually establishes the acute event and the culprit vessel.

What CPT 92941 covers

92941 is percutaneous transluminal revascularization of an acute total or subtotal occlusion during acute myocardial infarction, using any combination of intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, for a single major coronary artery and/or its branches, or a single bypass graft and/or its subtended branches.

Non-emergent revascularization of or through a bypass graft is 92937, not 92941.

Two points are routinely misunderstood. The descriptor is not limited to ST-elevation MI, and aspiration thrombectomy is included rather than separately reportable.

What changed for 2026

The PCI codes were restructured this year, and claims built on the old structure will not survive:

The additional-branch add-on codes were deleted, including 92921, 92925, 92929, 92934, 92938 and 92944. Do not report them for dates of service in 2026.
The base codes were revised to read "branch(es)", so typical additional branch work within the same major coronary artery is now included in the base code rather than billed separately.
92930 is new, for stenting of two or more distinct coronary lesions with two or more stents deployed in two or more coronary segments, or a bifurcation lesion requiring angioplasty and/or stenting in both the main artery and the side branch. 92928 was narrowed to match: it now reads one lesion involving one or more coronary segments, and is used for a single lesion regardless of the number of stents or segments.
92945 is new, for revascularization of a chronic total occlusion by combined antegrade and retrograde approaches. It sits alongside the existing 92943, which remains the code for a CTO treated by the antegrade approach alone. The CTO codes already include any combination of stent, atherectomy and angioplasty, so those codes are not added for the same occlusion.
"Coronary segments" are now formally defined. CPT adopted the 29-segment anatomical model used by the National Cardiovascular Data Registry CathPCI database, so documentation has to identify the segment treated, not just the vessel.
Coronary thrombolysis codes 92975 and 92977 were deleted.

If your charge master or scrub rules still reference 92921, 92929, 92934 or 92944, they are producing rejections on every multi-branch case. That is the first thing to check.

Vessel rules and modifiers

PCI codes are reported per major coronary artery, and the vessel has to be identified on the claim:

LD: left anterior descending.
LC: left circumflex.
RC: right coronary.
LM: left main.
RI: ramus intermedius.

One base code per major vessel treated. A second major vessel takes its own base code with its own vessel modifier. Branches within the same major vessel are now part of the base code rather than a separate line. CPT counts up to two branches of the left anterior descending (diagonals), left circumflex (marginals) and right (posterior descending, posterolaterals); the left main and ramus intermedius have none.

Work in a native coronary artery can be reported separately from work performed through a bypass graft, and work on separate lesions in different major arteries is separately reportable.

Where more than one intervention type is performed in the same vessel, report the single most intensive service for that vessel rather than stacking codes. Where a single lesion bridges two vessels but is treated with one intervention, only one code is reported.

The wider family beyond these four: 92924 atherectomy without a stent, 92937 revascularization of or through a bypass graft, 92943 and 92945 for chronic total occlusions.

Reimbursement context

The PCI codes were restructured for 2026, so figures quoted from earlier years no longer apply.

Medicare pays for this code under the Physician Fee Schedule, and the amount depends on where you practise. Each code carries relative value units for physician work, practice expense and malpractice, each adjusted by a geographic practice cost index (GPCI) for the locality, and the total is multiplied by the conversion factor:

(work RVU × work GPCI + practice expense RVU × PE GPCI + malpractice RVU × MP GPCI) × conversion factor

For 2026 the conversion factor is $33.4009 for practitioners who are not qualifying APM participants and $33.5675 for qualifying APM participants, as set in the CY 2026 Physician Fee Schedule final rule (CMS-1832-F; see the CMS fact sheet). Because the RVUs differ by code and the GPCIs differ by locality, what your practice is paid will differ from any national average. Pull the RVUs and the payment for your own locality from the CMS Physician Fee Schedule Look-Up Tool.

Documentation requirements

The vessel treated, named specifically, and every branch involved.
The coronary segment(s) treated, per the 29-segment model CPT adopted for 2026. Segment-level detail is what separates one lesion from two, and therefore 92928 from 92930.
Lesion location, length and percentage stenosis before and after, and the number of stents deployed.
Devices used, including stent type, size and number.
The clinical indication for intervention, including ischemia evidence where required by payer policy.
Whether a diagnostic study preceded the intervention in the same session, and if so, why it was necessary and not already available.
Contrast volume, fluoroscopy time and any complications.
A signed procedure note naming each intervention performed per vessel.

Common denials and the exact fix

Acute MI not established in the record

The premium this code carries rests on the emergent circumstance. A note that documents an occlusion without establishing the acute infarction will not hold up.

Fix: document the presenting event, the supporting ECG and biomarker findings, and the timing, alongside the angiographic finding of acute total or subtotal occlusion.

Culprit vessel not identified

92941 is reported for the vessel treated as the culprit for the infarct.

Fix: name the culprit vessel explicitly and carry the matching vessel modifier. Non-culprit vessels treated in the same session are reported with the appropriate elective PCI code and their own vessel modifiers.

Aspiration thrombectomy billed separately

It is included in 92941 when performed.

Fix: remove the separate line.

Elective PCI code used for the culprit vessel

Reporting 92928 for a culprit lesion treated during an acute infarction under-reports the service on every affected case.

Fix: route acute MI cases through a coding check that identifies the culprit vessel and applies 92941 to it.

Deleted add-on code billed for additional branches

92944 was deleted for 2026.

Fix: remove the line; branch work is inside the base code.

Modifier rules

LC, LD, RC, RI, LM: required to identify the vessel treated. A missing vessel modifier is one of the most common PCI rejections, and duplicate-vessel modifiers across lines will strip the second line.
59 / XE / XP / XS / XU: used where a genuinely distinct service is performed, most often a diagnostic study that led to the decision to intervene. It must be supported in the note, not applied because the line denied.
22: increased procedural services. Requires a narrative and goes to manual review.
26 / TC: applies in facility settings where the professional and technical components are billed separately.
78 / 79: return to the procedure room during a global period, either for a related complication or for an unrelated procedure.

NCCI bundling edits

92941 with aspiration thrombectomy: thrombectomy is included when performed.
92941 with 92920, 92928 or 92933 for the same vessel: 92941 absorbs the intervention performed on the culprit vessel.
Non-culprit vessels: reported separately with the appropriate elective PCI code and vessel modifier.
Deleted add-ons including 92944: not reportable for 2026.
Deleted thrombolysis codes 92975 and 92977: removed for 2026.

Frequently asked questions

Is CPT 92941 limited to STEMI?

No. The descriptor covers revascularization of an acute total or subtotal occlusion during acute myocardial infarction and is not restricted to ST-elevation infarction. What matters is that the record establishes the acute infarction and the angiographic finding of acute total or subtotal occlusion in the treated vessel.

Is aspiration thrombectomy separately billable with 92941?

No. Aspiration thrombectomy is included in 92941 when performed, so a separate line duplicates work the code already covers.

How do I report non-culprit vessels treated in the same session?

92941 applies to the culprit vessel for the infarct. Any other major coronary artery treated in the same session is reported with the appropriate elective PCI base code and its own vessel modifier.

What documentation supports the acute MI premium?

The presenting event, supporting ECG and biomarker findings, timing, and the angiographic description of acute total or subtotal occlusion in the culprit vessel. Documenting the occlusion alone, without establishing the acute infarction, is the most common reason this code fails review.

Sources

American Medical Association, CPT 2026 Professional Edition.
Centers for Medicare & Medicaid Services, National Correct Coding Initiative Policy Manual and quarterly edit tables, cms.gov.
Centers for Medicare & Medicaid Services, Physician Fee Schedule Look-Up Tool, cms.gov.
American College of Cardiology, acc.org. AAPC coding resources, aapc.com.

CPT® is a registered trademark of the American Medical Association. Code descriptors are summarised here for billing guidance and are not a substitute for the current CPT codebook. Payer rules and NCCI edits change quarterly; verify against your own payer policy before submission.

Related codes

CPT 92928. Coronary stent, one lesion, single major vessel.
CPT 92933. Coronary atherectomy with stent, single major vessel.
CPT 92945. CTO revascularization, antegrade and retrograde.

CPT 92941: Percutaneous Revascularization During Acute Myocardial Infarction