CPT 92943 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Cardiovascular Procedures |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • RC - Right coronary artery • LD - Left anterior descending coronary artery |
| Complexity Level | Moderate |
National average reimbursement for CPT 92943 by major payers:
$905.33
$919.78
$884.04
$1,073.96
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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CPT 92943 vs. Other Cardiovascular Procedures Codes
The CPT 92943 code is part of the Medicine Services and Procedures services used for Cardiovascular Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 92943 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 92928 | Moderate | Percutaneous Transcatheter Placement Of Intracoronary Stent(S) With Coronary Angioplasty When Performed; Single Major Coronary Artery Or Branch |
| 92937 | Moderate | Percutaneous Transluminal Revascularization Of Or Through Coronary Artery Bypass Graft (Internal Mammary Free Arterial Venous) Any Combination Of Intracoronary Stent Atherectomy And Angioplasty Including Distal Proctection When Performed; Single Vessel |
| 92938 | Moderate | Percutaneous Transluminal Revascularization Of Or Through Coronary Artery Bypass Graft (Internal Mammary Free Arterial Venous) Any Combination Of Intracoronary Stent Atherectomy And Angioplasty Including Distal Protection When Performed; Each Additional Branch Subtended By Thebypass Graft (List Separately In Addition To Code For Primary Procedure) |
| 92943 | Moderate | Percutaneous Transluminal Revascularization Of Chronic Total Occulsion Coronary Artery Coronary Artery Branch Or Coronary Artery Bypass Graft Any Combination Of Intracoronary Stent Atheredtomy And Angioplasty; Single Vessel |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 92943. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 92943 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
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