Medicare Cardiac Catheterization Cost 2026 | Out-of-Pocket Estimator
Left heart catheterization with coronary angiography (CPT 93458) is a diagnostic cardiac procedure covered by Medicare. Both HOPD and ASC settings are available; ASC can offer significant cost savings.
2026 Medicare Cost Summary — Cardiac Catheterization (CPT 93458)
Source: CMS 2026 MPFS, OPPS Final Rule, ASC Final Rule, IPPS. All amounts are national averages.
| Cost Component | Medicare-Approved Amount | Your Share (20%) |
|---|---|---|
| Surgeon Fee — Cardiac Catheterization (CPT 93458) | $1,010 | $202 |
| Hospital Outpatient (HOPD) Facility Fee | $3,312 | $662 |
| Ambulatory Surgery Center (ASC) Facility Fee | $1,707 | $341 |
| Inpatient Hospital (DRG 287) — Medicare Pays | $7,787 | $1,736 Part A deductible |
| Anesthesia (estimated) | $300–$600 | 20% of approved |
What Medicare Pays
Medicare pays 80% of the approved amount for Part B services after your $283 annual deductible. With no supplemental insurance, you owe the remaining 20% with no annual out-of-pocket cap. With Medigap Plan G, you pay only the $283 Part B deductible — everything else is covered. With Medigap Plan N, you pay the $283 deductible plus a $20 copay per visit.
About This Calculator
MediCostCalc uses 2026 CMS official fee schedules — the Medicare Physician Fee Schedule (MPFS), Outpatient Prospective Payment System (OPPS), Ambulatory Surgical Center (ASC) Final Rule, and Inpatient Prospective Payment System (IPPS) — to give you a personalized, line-item cost estimate. No sign-up required. All data is from official CMS sources.
Does Medicare Cover Cardiac Catheterization?
Yes. Medicare Part B covers diagnostic cardiac catheterization (left heart cath with coronary angiography, CPT 93458) as a medically necessary procedure when ordered by your cardiologist. You pay the standard 20% coinsurance after meeting your $283 annual Part B deductible. There is no annual out-of-pocket maximum under original Medicare — that's why many patients add a Medigap supplement.
Diagnostic Cath vs. Interventional (PCI): Why It Matters for Your Bill
A cardiac catheterization can be purely diagnostic (look only) or it can become interventional if a blockage is found and stented during the same session. These are billed differently:
| Procedure Type | Typical CPT | HOPD Facility Fee | Your 20% |
|---|---|---|---|
| Diagnostic only (left heart cath + angiography) | 93458 | $3,312 | $662 |
| Percutaneous coronary intervention (PCI/stent) | 92928 | $14,200+ | $2,840+ |
If a stent is placed, the interventional CPT code replaces the diagnostic code — you are not billed for both. However, multiple stents or complex lesions add further CPT codes and increase your cost share.
Outpatient vs. Inpatient: A Major Cost Difference
Many diagnostic catheterizations are now performed in a hospital outpatient cath lab (same-day discharge). If complications arise or a stent is placed, you may be admitted inpatient — and the billing switches from Part B to Part A.
| Setting | Medicare Payment | Your Cost |
|---|---|---|
| Hospital Outpatient (HOPD) — diagnostic cath | $3,312 facility + $1,010 physician | $662 + $202 = ~$864 |
| Inpatient (DRG 287 — circulatory disorders w/ cardiac cath, w/o MCC) | $7,787 bundled | $1,736 Part A deductible |
For a same-day outpatient diagnostic cath without a Medigap plan, your total estimated out-of-pocket is roughly $864 (facility 20% of $3,312 = $662, plus physician 20% of $1,010 = $202). With Medigap Plan G, you pay only the $283 Part B deductible — the rest is covered.