CPT 92945 Billing: CTO Antegrade and Retrograde

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 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

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 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

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, 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 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.

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