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The individuals who appear are for illustrative purposes. All persons depicted are models and not real healthcare professionals. US-N/A-2400043 05/24

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Coding for noninvasive estimated coronary fractional flow reserve (FFR) tomography performed for different reasons

Q.

I have a question about fractional flow reserve (FFR) derived from CTA billing. Is Category lll CPT® code 0501T a global code only? Should a hospital bill using Category lll codes 0502T and 0503T, and the physician practice then use Category lll code 0504T, or is this considered unbundling?

A.

Category lll CPT code 0501T is a global code and includes everything in Category lll codes 0502T–0504T. It may not be billed by the hospital. 

Category lll CPT code 0504T is also not billable by the hospital as it describes the physician review and report. 

The hospital may, however report Category lll code 0502T. but it is packaged (a status indicator of N), and not separately payable. The hospital may also report 0503T, and it is separately payable (a status indicator of S). The current Medicare national payment rate is $950.50. 

These codes may only be reported once per coronary CTA. 

The codes and full descriptions are as follows:

0501T  Noninvasive estimated coronary fractional flow reserve (FFR) derived from  coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; data preparation and transmission, analysis of fluid dynamics and simulated maximal coronary hyperemia, generation of estimated FFR model, with anatomical data review in comparison with estimated FFR model to reconcile discordant data, interpretation and report

0502T  Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; data preparation and transmission

0503T  Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to  assess the severity of coronary artery disease; analysis of fluid dynamics and simulated maximal coronary hyperemia, and generation of estimated FFR model

0504T  Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; anatomical data review in comparison with estimated FFR model to reconcile discordant data, interpretation and report