A cardiac stent procedure can arrive at your door as a $60,000 hospital bill — or a $6,000 one, depending on which line items your hospital decides to list, how aggressively you negotiate, and whether anyone catches the errors before you pay. The procedure code is CPT 92928. The Medicare rate for the physician fee is $463.94 in 2026. The average hospital chargemaster price for the same event can run 60 to 100 times that. Understanding the gap between those two numbers is how patients avoid overpaying by tens of thousands of dollars.
Quick Answer: A heart stent (CPT 92928) costs $20,000–$60,000 at hospital chargemaster prices in 2026. Medicare pays roughly $8,000–$15,000 via DRG for inpatient cases. Uninsured patients often qualify for charity care that reduces or eliminates the bill entirely. The single most useful step is uploading your itemized bill to the CoveredUSA Bill Analyzer to identify overcharges and errors before you pay.
What CPT 92928 Actually Covers
CPT 92928 is the procedure code for percutaneous transcatheter placement of an intracoronary stent with coronary angioplasty, single major coronary artery or branch, single lesion. In plain language: a cardiologist threads a catheter through an artery, inflates a small balloon to open a blockage, and deploys a mesh tube (the stent) to hold the vessel open.
The code covers one artery with one lesion. Additional vessels or lesions require add-on codes (CPT 92929 for each additional branch on the same artery). Emergency cases during an active heart attack use different DRG groupings that affect the total facility payment.
Related codes you may see on the same bill:
- CPT 93454–93461 — Coronary angiography (usually performed during the same session)
- CPT 92920 — Balloon angioplasty without stent placement
- CPT 93975 — Peripheral vascular studies if done concurrently
- CPT 93503 — Right heart catheterization
Each of these generates a separate charge. A single cath lab visit for stent placement commonly produces 8 to 15 line items on the final bill.
2026 Cost Breakdown: What You Are Actually Paying For
Hospitals charge for four separate buckets during a stent procedure. Most patients see a single large number on their explanation of benefits, but the components are:
| Cost Component | Typical Range (2026) | Notes |
|---|
| Hospital facility fee (outpatient) | $15,000–$40,000 | Includes cath lab, nursing, supplies |
| Physician fee (CPT 92928) | $800–$3,500 | Cardiologist's professional fee |
| Stent device cost | $1,500–$3,000 (drug-eluting) | Billed as a supply charge |
| Anesthesia / sedation | $500–$2,000 | Sometimes bundled, sometimes separate |
| Total (outpatient, elective) | $20,000–$48,000 | Median national chargemaster |
| Total (inpatient, emergency/STEMI) | $35,000–$75,000+ | Adds ICU, multi-day room and board |
Source: Medicare.gov Procedure Price Lookup for CPT 92928 shows a national median facility cost of $11,901 for the outpatient facility component alone. Chargemaster prices (what uninsured patients are initially billed) run two to four times the Medicare allowed amount.
What Medicare Pays for CPT 92928 in 2026
Medicare's 2026 physician fee schedule sets the national average payment for CPT 92928 at $463.94 for the professional (physician) component, per CMS fee schedule data. That number reflects a -16.66% change from the prior year, driven by adjustments to the conversion factor and relative value unit weights for this code.
For the facility side, Medicare pays via Diagnosis Related Groups (DRGs) for inpatient admissions and via the Outpatient Prospective Payment System (OPPS) for same-day cases. Inpatient PCI typically falls into DRG 246–249, with Medicare payments in the range of $8,000–$15,000 total to the hospital — not the $30,000–$60,000 the chargemaster shows.
Medicare patient out-of-pocket (2026):
- Part A deductible: $1,736 per benefit period
- Days 1–60 inpatient: $0 coinsurance after the deductible
- Outpatient (OPPS): 20% coinsurance after the Part B deductible ($283)
For Medicare patients, the effective out-of-pocket for a stent is often $2,000–$4,500 if they have no supplemental (Medigap) coverage, and effectively $0 with a strong Medigap plan.
What Private Insurance Pays
Private insurers negotiate rates with hospitals that typically land between Medicare rates and chargemaster rates. Depending on the insurer's network contract:
- In-network: Patient pays deductible plus 10–30% coinsurance. On a $35,000 negotiated rate with 20% coinsurance and a $3,000 deductible already met, out-of-pocket is $7,000.
- Out-of-network: No negotiated rate. The insurer may pay a percentage of the chargemaster amount, leaving the patient exposed to balance billing. Out-of-pocket in this scenario can reach $20,000–$40,000.
The No Surprises Act (2022) limits balance billing for many out-of-network emergency situations, including emergency stent placements during a heart attack. Elective stent procedures at out-of-network facilities are not automatically protected. Always verify the facility and the cardiologist are both in-network before a non-emergency procedure.
Uninsured? Charity Care Can Wipe Out the Bill
Federal law (IRS Section 501(r)) requires every nonprofit hospital — approximately 60% of U.S. hospitals — to maintain a financial assistance policy and apply it to patients who qualify. Most programs use Federal Poverty Level (FPL) thresholds to determine eligibility.
2026 Charity Care Income Thresholds (Federal Poverty Level)
| Household Size | 100% FPL (2026) | 200% FPL | 300% FPL | 400% FPL |
|---|
| 1 | $15,960 | $31,920 | $47,880 | $63,840 |
| 2 | $21,640 | $43,280 | $64,920 | $86,560 |
| 3 | $27,320 | $54,640 | $81,960 | $109,280 |
| 4 | $33,000 | $66,000 | $99,000 | $132,000 |
| 5 | $38,680 | $77,360 | $116,040 | $154,720 |
| 6 | $44,360 | $88,720 | $133,080 | $177,440 |
| 7 | $50,040 | $100,080 | $150,120 | $200,160 |
| 8 | $55,720 | $111,440 | $167,160 | $222,880 |
| Each additional | +$5,680 | +$11,360 | +$17,040 | +$22,720 |
Source: HHS ASPE 2026 Poverty Guidelines
Typical financial assistance tiers at nonprofit hospitals:
- At or below 200% FPL: 100% of the bill forgiven
- 201% to 300% FPL: 75% discount (sliding scale)
- 301% to 400% FPL: 55% discount (sliding scale)
- Above 400% FPL: Payment plans; interest-free installments common
A family of four earning $55,000 in 2026 falls at roughly 167% FPL — well within the free care threshold at most nonprofit hospitals. That $45,000 stent bill can legally go to $0.
What to do: Request the hospital's financial assistance application before paying anything. Federal law gives you 240 days from the first bill to apply. Most hospitals will pause collection during the review.
Common Billing Errors on Stent Bills
This is where the CoveredUSA Bill Analyzer earns its keep. The CoveredUSA Bill Analyzer compares each line on your itemized bill against Medicare reference rates and flags charges that exceed typical benchmarks, duplicate services, and codes that should be bundled under CPT 92928 but are billed separately.
Common billing errors specific to cardiac stent procedures:
1. Unbundling of included services. CPT 92928 includes imaging guidance (fluoroscopy) and the angioplasty itself. Billing fluoroscopy (CPT 77001) or the angioplasty separately (CPT 92920) alongside 92928 is an unbundling violation. It inflates the bill and violates CMS bundling rules.
2. Duplicate angiography charges. Coronary angiography is often performed immediately before stent placement during the same cath lab session. If the angiography was diagnostic (CPT 93454) and the stent was placed in the same session, the angiography may be bundled into the facility fee depending on the payer. Separate charges for both in an outpatient setting warrant scrutiny.
3. Room and board for a same-day procedure. Elective stent placements are increasingly done as outpatient (same-day discharge) procedures. If the bill shows inpatient room charges when you were discharged the same day, the facility may have incorrectly classified the admission.
4. Modifier errors. Missing or incorrect modifiers (like modifier 26 for professional interpretation only, or modifier 59 for distinct procedural service) can cause insurance to deny or over-pay certain line items, triggering incorrect patient responsibility.
5. Supply charge inflation. The stent device itself (a drug-eluting stent) costs the hospital $1,500–$3,000. Some facilities bill supply charges of $8,000–$12,000 for the same device. The markup is legal in a charge sense but is often negotiable.
Per OIG enforcement records, billing for unnecessary stent procedures and unbundling are two of the most common cardiology fraud categories. These aren't rare edge cases.
How to Apply for Financial Assistance: Step by Step
Documents You Will Need
- Photo ID (driver's license or passport)
- Proof of income (last two months of pay stubs, or most recent tax return)
- Bank statements (last 2–3 months) — some hospitals require these
- Insurance cards or denial letters (if applicable)
- The itemized hospital bill
Application Steps
- Request the itemized bill. Ask the billing department for a line-by-line itemized statement, not just a summary. This is your legal right.
- Look up the hospital's financial assistance policy. Nonprofit hospitals must post this online. Search "[Hospital Name] financial assistance policy" or ask at the billing window.
- Request the application form. Many hospitals have a charity care or financial counselor who can walk you through it.
- Gather your income documentation. FPL calculations are based on annual household income and household size. Include everyone in your tax household.
- Submit the application. Do this before paying any portion of the bill. Payment before the application is processed can sometimes reduce your leverage.
- Request a review period. Federal law requires hospitals to give you 240 days from the first bill date to apply for financial assistance without sending the account to collections.
- Appeal if denied. If the first determination seems wrong, appeal in writing. Errors in household size, income calculation, or program eligibility are common.
Common Reasons Applications Are Denied
- Income documentation is incomplete (missing a W-2, Social Security statement, or self-employment records)
- Household size listed does not match tax return
- Application submitted after the 240-day window
- Hospital is for-profit (not legally required to offer charity care, though many do)
- Patient provided incorrect contact information and missed follow-up requests
If your application is denied and you believe you qualify, contact your state's hospital association or a patient advocate. Many states have additional hospital billing laws that go beyond the federal requirements.
What If You Have Insurance but Still Got a Large Bill?
This situation is common. A KFF Health News investigation documented a patient who received a $109,000 bill after a heart attack despite having insurance. The culprit: out-of-network providers in an in-network facility, surprise billing loopholes, and errors the insurer processed incorrectly.
Steps if you have insurance but the bill looks wrong:
- Compare the explanation of benefits (EOB) to the itemized hospital bill. Line items should match.
- Look for any out-of-network provider charges (often the anesthesiologist or a consulting cardiologist).
- File an appeal with your insurer citing specific line items.
- Request an independent dispute resolution (IDR) process under the No Surprises Act for qualifying surprise bills.
- Upload the itemized bill to the CoveredUSA Bill Analyzer to flag specific lines that exceed Medicare benchmarks — those are your strongest negotiating points.
Next Steps to Reduce Your Bill
Upload your hospital bill to the free CoveredUSA Bill Analyzer to find errors, overcharges, and charity care options in 30 seconds. The analyzer flags line items that exceed Medicare reference rates, identifies unbundled codes, and estimates what you should actually owe based on your coverage type.
Frequently Asked Questions
What is CPT 92928?
CPT 92928 is the procedure code for percutaneous transcatheter placement of an intracoronary stent, with coronary angioplasty, for a single major coronary artery or branch with a single lesion. It is the standard code used when a cardiologist places a stent to treat a coronary blockage during a catheterization procedure.
How much does Medicare pay for CPT 92928 in 2026?
Medicare's 2026 physician fee schedule pays a national average of $463.94 for the professional (physician) component of CPT 92928. This reflects the cardiologist's fee only. The hospital facility fee is paid separately via the Outpatient Prospective Payment System (OPPS) or the inpatient DRG system, and ranges from $8,000 to $15,000 for the total hospital payment on an inpatient case.
Why is my stent bill so much higher than what Medicare pays?
Hospitals set chargemaster prices (the "list price") that are often 3 to 10 times higher than what Medicare or private insurers actually pay. Uninsured patients are often billed the chargemaster rate initially, though they have the right to request the self-pay rate (typically 40–60% lower) and to apply for charity care. The gap between the chargemaster price and what anyone actually pays is one of the most persistent sources of confusion in U.S. hospital billing.
Can I get a stent for free if I have no insurance?
If you qualify for charity care at a nonprofit hospital, yes. Patients at or below 200% of the 2026 Federal Poverty Level ($31,920 for a single person; $66,000 for a family of four) typically qualify for 100% bill forgiveness. Apply before paying anything and within 240 days of the first bill.
What are the most common billing errors on a stent bill?
The most common errors are: (1) unbundling of services that CPT 92928 already includes, such as billing fluoroscopy or angioplasty separately; (2) duplicate charges for angiography done in the same session; (3) incorrect inpatient classification for a same-day procedure; and (4) supply charge inflation on the stent device itself. Upload your itemized bill to the CoveredUSA Bill Analyzer to check for these automatically.
Does the No Surprises Act protect me during an emergency stent procedure?
Yes, for emergency situations. If you receive a stent during an emergency (such as a heart attack) and are treated by out-of-network providers, the No Surprises Act limits what those providers can bill you to your in-network cost-sharing amount. You must receive a notice about out-of-network billing, and you have the right to dispute surprise bills through the IDR process. Elective, non-emergency stent procedures at facilities you choose do not receive the same automatic protection.
How do I get my itemized bill from the hospital?
Call the hospital billing department and specifically request an "itemized statement" or "itemized bill." Hospitals are required to provide this. The standard summary bill or EOB does not show individual CPT codes and charge amounts. You need the line-by-line version to check for errors.
What is the difference between a drug-eluting stent and a bare-metal stent for billing?
Drug-eluting stents (DES) and bare-metal stents (BMS) both bill under CPT 92928 for the procedure itself. The difference shows up as a supply or device charge line item on the facility bill. A drug-eluting stent typically costs the hospital $1,500–$3,000 and may be billed to patients or insurers at $3,000–$8,000. Bare-metal stents cost $500–$1,000 wholesale and are rarely used today. The supply charge is frequently negotiable, particularly for uninsured patients requesting charity care.
