CPT 93454 covers coronary angiography performed on its own, without a right or left heart catheterization. It is the code most often billed by mistake, because it describes work that four higher-level codes in the same family already contain.
What CPT 93454 covers
93454 is catheter placement in the coronary artery(ies) for coronary angiography, including the intraprocedural injections for that angiography and the imaging supervision and interpretation.
It is correct only when coronary angiography was the whole study. If a right heart catheterization, a left heart catheterization or bypass graft imaging was also performed in the same session, a combined code replaces 93454 entirely.
Where 93454 sits in the cath family
93454 is coronary angiography alone, with no heart catheterization. Add bypass graft angiography and it becomes 93455. Add right heart catheterization and it becomes 93456 (93457 with grafts); add left heart catheterization and it becomes 93458 (93459 with grafts); both sides, 93460 or 93461. 93454 next to 93458 for the same session is the classic error, because 93458 already contains the angiography. See the complete 93451 to 93461 code map on the CPT 93458 guide.
Reimbursement context
93454 splits into professional and technical components, and the setting decides which you may report.
2026 Medicare RVUs for CPT 93454
| CPT 93454: 2026 Medicare RVUs (national, before GPCI) | ||||||
|---|---|---|---|---|---|---|
| Line | Work | PE, non-facility | PE, facility | Malpractice | Total, non-facility | Total, facility |
| Global (no modifier) | 4.43 | 20.93 | NA | 0.92 | 26.28 | NA |
| Professional (modifier 26) | 4.43 | 1.68 | 1.68 | 0.87 | 6.98 | 6.98 |
| Technical (modifier TC) | 0.00 | 19.25 | NA | 0.05 | 19.30 | NA |
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 93454 carries 4.43 work RVUs and 26.28 total RVUs when billed globally in a non-facility setting. The global line is NA in a facility, because there the physician bills the professional component only and the facility bills the technical side. Its PC/TC indicator is 1: the code splits into a professional component (modifier 26, 6.98 total RVUs) and a technical component (modifier TC, 19.30 total RVUs), and the global line is billed only when one entity does both. Its global period is 000: related work on the day of the procedure is included, with no postoperative days. Across the diagnostic catheterization family, work RVUs run from 2.41 (93451) to 7.65 (93461); 93454 sits at 4.43.
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 cardiac indication that justified the study, coded specifically.
- Access site, sheath and each catheter used.
- Every vessel or chamber selectively engaged, with findings.
- Hemodynamic measurements obtained, including pressures, gradients and saturations where applicable.
- Contrast volume and fluoroscopy time.
- A signed interpretation naming the study actually performed.
- Where an intervention followed in the same session, why the diagnostic study was necessary and not already available.
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: A52850 (Cardiac Catheterization and Coronary Angiography, Wellpoint Federal) and A56500 (Cardiac Catheterization and Coronary Angiography, CGS). Use the article from the contractor that processes your claims.
Common denials and the exact fix
CO-97: 93454 billed alongside 93458, 93459, 93460 or 93461
Every one of those codes already includes coronary angiography. Reporting 93454 next to them bills the angiography twice, and it is the single most common bundling denial in the cath lab.
Fix: remove the 93454 line and report the combined code alone. Do not append modifier 59. This is a code-selection error, and a reflexive 59 is the pattern that triggers a wider audit.
Right heart catheterization performed in the same session
93451 next to 93454 describes coronary angiography with a right heart study.
Fix: report 93456, or 93457 where bypass grafts were also imaged.
Bypass grafts imaged but 93454 reported
Graft angiography is not inside 93454.
Fix: report 93455 for coronary plus graft angiography alone, or the appropriate combined code where a heart catheterization was also performed.
CO-236: access, closure and guidance billed separately
These are inside the code through the same access.
Fix: remove those lines.
CO-50: indication does not support angiography
A diagnostic coronary angiogram needs a documented clinical question.
Fix: code the actual indication and ensure it appears in the record.
What is already inside these codes
- Vascular access and sheath placement through the same access.
- Fluoroscopic guidance and roadmapping.
- Closure devices.
- The intraprocedural injections for the angiography described by the code.
- Imaging supervision and interpretation.
Billing any of these separately on the professional claim produces a CO-236 unbundling denial. Hospitals may still report closure device placement with HCPCS G0269, but it is packaged into the procedure rather than paid separately.One add-on is separately reportable with 93454 when genuinely performed and documented: 93567 for supravalvular aortography. Pulmonary artery angiography, 93568, pairs only with codes that include a right heart catheterization, so it is not reported with 93454.
Modifier rules
- 26 / TC: 93454 splits by setting. In a hospital the physician bills modifier 26 and the facility reports the technical side; the global line is only for one entity furnishing both. A modifier that contradicts the place of service is the most common modifier denial on 93454.
- 59 / XE / XP / XS / XU: only for a genuinely distinct service in a separate session, site or encounter. Coronary angiography is already inside 93455 to 93461, so no modifier rescues a 93454 line billed next to any of them for the same session.
- 51: multiple procedures; most payers apply it automatically.
- 22: increased procedural services on 93454 is rare, needs a narrative and goes to manual review.
- LC, LD, RC, RI, LM: vessel modifiers belong on intervention codes, not on 93454.
NCCI bundling edits
- 93454 is a component of 93458, 93459, 93460 and 93461. Never report it alongside them. This is the highest-volume cath bundling edit.
- 93454 with 93451: resolves to 93456.
- 93454 with 93452: resolves to 93458.
- Access, closure, guidance and angiographic injections are included.
- 93567: separately reportable where genuinely performed. 93568: not reported with 93454, because it pairs only with codes that include right heart catheterization.
Frequently asked questions
Why does CPT 93454 deny with 93458?
Can modifier 59 make 93454 payable alongside 93458?
When is 93454 the correct code?
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 93454.
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.
Medicare Coverage Database billing and coding articles A52850, A56500.
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 93458. Left heart cath with coronary angiography.
- CPT 93460. Right and left heart cath with coronary angiography.
- CPT 93459. Left heart cath with coronary and bypass graft angiography.
Related reading
- Cardiology billing & RCM. How we scrub cardiology claims across diagnostics, cath lab, EP and remote monitoring.
- Cardiac cath billing: NCCI bundling and modifier 59. Where cath lab bundling edits bite, and when a distinct-service modifier is genuinely earned.
- TC/26 modifier errors in cardiology. The split-billing mistakes that cost diagnostic practices the most.
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