The Centers for Medicare and Medicaid Services (CMS) has proposed updated values to the PCI family of codes in the proposed 2026 Medicare Physician Fee Schedule (PFS), following revisions made by the CPT Editorial Panel in February 2024 and revaluation by the American Medical Association Relative Value Scale Update Committee (RUC) in April 2024.

Two new CPT codes were created within the family. The first, temporarily labeled as 92X01, is described as "Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed, single major coronary artery and/or its branch(es); two or more distinct coronary lesions with two or more coronary stents deployed in two or more coronary segments, or a bifurcation lesion requiring angioplasty and/or stenting in both the main artery and the side branch)." This code was created to address the increased resources required when performing a more complex stent procedure not fully captured in the current 92928 code.

The second, temporarily labeled as 92X02, is described as, "Percutaneous transluminal revascularization of chronic total occlusion, single coronary artery, coronary artery branch, or coronary artery bypass graft, and/or subtended major coronary artery branches of the bypass graft any combination of intracoronary stent, atherectomy and angioplasty; combined antegrade and retrograde approaches." This code was created to address the increased resources deployed when treating a chronic total occlusion requires both antegrade and retrograde approaches.

The RUC surveyed the entire family of PCI codes in April 2024 with one exception – Coronary Intravascular Lithotripsy (IVL), 92972. The committee reaffirmed its value, which was established in January 2023. CMS proposes to adopt the RUC recommended work relative value units (RVUs) for all surveyed PCI codes (see chart below).

*RVU for code procedure would have been billed under prior to creation of new code.

Several code RVUs decreased while others increased. When accounting for utilization via the most recently available data (with estimates for new codes), the family as a whole is expected to lose less than 2% of its total work RVUs.

These updates reflect only the changes in work RVU from the latest survey of the PCI family. CMS is also proposing an efficiency adjustment that would reduce these work RVUs by 2.5% as well as shifts in indirect practice expense that would further reduce many of these codes. The full impact of these changes can be seen in the ACC's Medicare PFS calculator.

Why was the PCI family of codes revised and resurveyed?

The CPT Editorial Panel approved a category I code for IVL at the September 2022 meeting after application for a new CPT code by the manufacturer. When new code(s) are added to a family or codes within a family are substantially revised, the RUC surveys the family for an updated valuation. Generally, if the family had been surveyed within the past five years, the values could simply be reaffirmed. At the time the IVL code was introduced, the PCI family had not been updated in over 10 years, necessitating a resurvey.

The IVL code was surveyed at the next RUC meeting in January 2023. The remainder of the PCI code set was submitted for revisions at CPT prior to being updated. The primary revisions included deleting additional branch add-on codes to 92920-92943, which had never been assigned RVUs by CMS; creating the complex stenting code; and creating the code for chronic total occlusion with combined antegrade and retrograde approaches.

The PCI revisions were passed by the CPT Editorial Panel in February 2024. The family was then resurveyed (except for IVL) for the April 2024 RUC meeting. These recommendations were then presented to CMS and incorporated into the proposed 2026 Medicare PFS.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Relative Value Scales, ACC Advocacy, Percutaneous Coronary Intervention, Centers for Medicare and Medicaid Services, U.S., Current Procedural Terminology, Lithotripsy, Physicians, Medicare