CPT 92945 Billing: CTO Antegrade and Retrograde

Mukesh MakwanaFounder & CEO · Hands-on medical billing & RCM across 11 specialties · Reviewed September 28, 2026

CPT 92945 is the new 2026 code for revascularization of a chronic total occlusion using combined antegrade and retrograde approaches. It sits beside 92943, which still covers a CTO treated antegrade alone, and the coding question on almost every CTO case is which of the two the note actually supports.

What CPT 92945 covers

92945 is percutaneous transluminal revascularization of a chronic total occlusion in a single coronary artery, coronary artery branch, or coronary artery bypass graft and/or subtended major coronary artery branches of the bypass graft, with any combination of intracoronary stent, atherectomy and angioplasty, by combined antegrade and retrograde approaches.

Antegrade only, or both

The two CTO codes share a descriptor apart from the final phrase:

92943: antegrade approach.
92945: combined antegrade and retrograde approaches.

Both cover any combination of stent, atherectomy and angioplasty, and both apply to a native artery, a branch, or a bypass graft with its subtended branches. The approach is what separates them, so the record has to show how the occlusion was actually crossed: the antegrade attempt, how retrograde access was obtained, and which route achieved the result.

Vessel modifiers on a 92945 claim

92945 is reported for the chronic total occlusion treated by combined antegrade and retrograde approaches, with the modifier for the artery involved. It already includes any combination of stent, atherectomy and angioplasty for that occlusion, so those codes are not added for the same occlusion. A CTO treated by the antegrade approach alone is 92943 instead. See the full vessel and branch rules on the CPT 92928 guide.

Reimbursement context

2026 Medicare RVUs for CPT 92945

CPT 92945: 2026 Medicare RVUs (national, before GPCI)
Line	Work	PE, non-facility	PE, facility	Malpractice	Total, non-facility	Total, facility
Global (no modifier)	15.00	NA	2.84	1.08	NA	18.92

Source: CMS CY 2026 PFS Relative Value File, RVU26D (October release, published 08/26/2026). RVUs are national and unadjusted; commercial payers set their own rates.

In the 2026 CMS relative value file, CPT 92945 carries 15.00 work RVUs and 18.92 total RVUs. The non-facility column is NA: CMS values this procedure only for a facility setting such as a hospital. Its PC/TC indicator is 0: CMS treats it as a physician service, so modifiers 26 and TC do not apply in any setting. Its global period is 000: related work on the day of the procedure is included, with no postoperative days. Across the PCI base codes, work RVUs run from 8.14 (92920) to 15.00 (92945), so 92945 carries the highest physician work in its group.

To turn RVUs into payment, each component is multiplied by your locality's geographic practice cost index, the three are added, and the sum is multiplied by the 2026 conversion factor: $33.4009, or $33.5675 for qualifying APM participants (CMS-1832-F; CMS fact sheet). The CMS Physician Fee Schedule Look-Up Tool runs that calculation for your locality.

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.

Medicare contractor billing articles. Each Medicare Administrative Contractor publishes its own billing and coding articles for this service, and the covered diagnoses differ by jurisdiction. Active examples in the CMS Medicare Coverage Database, checked September 28, 2026: A56823 (Percutaneous Coronary Intervention, Wellpoint Federal) and A57479 (Percutaneous Coronary Interventions, WPS). Use the article from the contractor that processes your claims.

Common denials and the exact fix

Combined approach performed but billed as 92943

The under-reporting error. Before 2026 there was one CTO code, so practices that never updated their charge master or coding template still bill the antegrade code for every CTO.

Fix: where the note documents both an antegrade and a retrograde approach, report 92945. Add a required field to the procedure note template for the approach or approaches used.

92945 billed without documentation of both approaches

The higher-value code has to be earned by the record. A note that describes an antegrade crossing, or that mentions a retrograde attempt without describing the access and result, does not establish a combined approach.

Fix: if the record supports an antegrade approach alone, the defensible code is 92943.

Deleted 92944 billed for an additional artery or graft

92944, the old add-on for each additional coronary artery, branch or graft treated as a CTO, was deleted for 2026.

Fix: remove the line. Work on separate lesions in different major coronary arteries is separately reportable, each with its own base code and vessel modifier.

Stent, atherectomy or angioplasty billed with the CTO code

The descriptor covers any combination of intracoronary stent, atherectomy and angioplasty, so those services are not billed again for the same occlusion.

Fix: report the CTO code alone for that occlusion.

Occlusion not documented as chronic and total

The premium rests on the lesion being a chronic total occlusion. A note that describes a severe stenosis, or an occlusion without evidence that it is long-standing, will not support a CTO code.

Fix: document the total occlusion on angiography and the evidence that it is chronic, such as prior imaging or history.

CO-50: indication does not support intervention

CTO revascularization is usually elective, and payers look for symptoms, ischemia or viability evidence before paying for it.

Fix: put the symptoms, ischemia testing and the reasoning for attempting the occlusion in the record, and check your MAC's PCI billing article.

Modifier rules

LC, LD, RC, RI, LM: required on every 92945 line to identify the vessel treated. A missing vessel modifier is one of the most common PCI rejections, and two lines carrying the same vessel modifier read as a duplicate.
59 / XE / XP / XS / XU: for a genuinely distinct service, most often a diagnostic study that led to the decision to intervene, and only when the note supports it. Note that stent, atherectomy and angioplasty for the same occlusion are inside 92945, so no modifier makes them separately payable.
26 / TC: not used. CMS gives CPT 92945 a PC/TC indicator of 0 (physician service), so it is billed without a component modifier in every setting, including the hospital.
22: increased procedural services on 92945. Requires a narrative and goes to manual review.
78 / 79: a return to the procedure room during the 92945 global day, for a related complication or an unrelated procedure.

NCCI bundling edits

92945 with 92943: the same occlusion is reported with one CTO code, chosen by the approach used.
92945 with 92920, 92928, 92930 or 92933: the descriptor includes any combination of stent, atherectomy and angioplasty, so those codes are not added for the same occlusion.
92945 with the deleted add-on 92944: not reportable for 2026.
Other lesions in different major arteries: separately reportable, each with its own base code and vessel modifier.
Diagnostic catheterization or angiography in the same session: reportable separately only when specifically diagnostic and supported in the note.
Vascular access, selective catheterization, traversing the lesion, imaging and closure are included in PCI codes.

Frequently asked questions

What is the difference between CPT 92943 and 92945?

The approach. 92943 is revascularization of a chronic total occlusion by the antegrade approach, and 92945, new for 2026, is the same service by combined antegrade and retrograde approaches. Both cover any combination of stent, atherectomy and angioplasty, so the procedure note has to show how the occlusion was actually crossed.

What happened to CPT 92944?

It was deleted for 2026. It was the add-on for each additional coronary artery, branch or bypass graft treated as a chronic total occlusion. Work on separate lesions in different major coronary arteries is now reported with its own base code and vessel modifier.

Can I bill a stent code with a chronic total occlusion code?

Not for the same occlusion. The CTO descriptors cover any combination of intracoronary stent, atherectomy and angioplasty, so those services are included and reporting a stent, atherectomy or angioplasty code for that occlusion duplicates work the code already covers.

How do I show a combined approach in the record?

Document the antegrade attempt, how retrograde access was obtained, for example through a collateral channel or a graft, and which route achieved the crossing and the final result. A note that mentions a retrograde attempt without those details does not establish a combined approach.

Sources

American Medical Association, CPT 2026 Professional Edition.
Centers for Medicare & Medicaid Services, CY 2026 PFS Relative Value File RVU26D (October release): RVUs, PC/TC indicator and global period for CPT 92945.
Centers for Medicare & Medicaid Services, CY 2026 Physician Fee Schedule final rule, CMS-1832-F: conversion factors.
Centers for Medicare & Medicaid Services, National Correct Coding Initiative Policy Manual for Medicare Services and quarterly procedure-to-procedure edit tables.
Society for Cardiovascular Angiography & Interventions, 2026 PCI CPT Coding Changes, and the American College of Cardiology Coding Corner overview of new CPT codes for 2026.
Medicare Coverage Database billing and coding articles A56823, A57479.

CPT® is a registered trademark of the American Medical Association. Payer policy and NCCI edits change quarterly, so check your own contractor before submission. How we verify this guidance.

Related codes

CPT 92930. Coronary stents, two or more lesions or a bifurcation.
CPT 92941. PCI during acute MI, culprit vessel.
CPT 92933. Coronary atherectomy with stent, single major vessel.

More cardiology code guides

CPT 93798. Cardiac rehab session with ECG monitoring.
CPT 93454. Coronary angiography, no heart catheterization.
CPT 93459. Left heart cath with coronary and bypass graft angiography.
CPT 93461. Right and left heart cath with coronary and graft angiography.

CPT 92945: Chronic Total Occlusion Revascularization, Combined Antegrade and Retrograde