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Billing code

Z440A — Left heart catheterization — retrograde aortic

Left heart catheterization

Bill for left heart catheterization by the retrograde aortic route; the transeptal approach is Z441.

Watch for: Each extra catheterization at the same sitting pays 50%, and G268 arterial cannulation isn't payable with Z440.

Code

Z440A

Description

Left heart catheterization — retrograde aortic

FHO+ basket

Not in the FHO+ base rate basket (Schedule 2 or 2B).

Effective date

Apr 1, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Left heart catheterization by the retrograde aortic route, part of haemodynamic studies in the cardiac catheterization lab.

What it covers

Z440 is left heart catheterization by the retrograde aortic approach, listed under Haemodynamic/Flow/Metabolic Studies; the transeptal approach is Z441 (J9).

Cardiac catheterization codes (Z439 to G288) include inserting the catheter (with cutdown and vessel repair if done), placing it, injecting contrast, imaging and interpretation (J9).

Billing rules

• When more than one catheterization procedure is done at one sitting, each additional procedure is paid at 50% of its listed fee; only G262 and G263 are exempt (J9).
• G268 (arterial cannulation for pressure measurements) is not payable with Z440 (J7).
• One G297 angiogram may be billed per left heart catheterization (J11).
• J021 and J022 (radiology catheter insertion and selective catheterization) are not payable in addition to cardiac catheterization procedures Z439 to G288 (E2).
• The # prefix means the fee does not include premises, equipment, supplies and personnel at the place where the procedure itself is done (J1, J3).
• Z-prefix codes in this section follow the Surgical Preamble (J1). As an independent operative procedure, if your decision-to-operate visit was in the prior 12 months, only a minor (GP) or partial (specialist) assessment is payable before it the same day (SP4 §13).
• Anaesthesia basic units are listed, so an anaesthetist claims the code with suffix C (SP5 §21).

Often billed with

• G297 angiogram, one per left heart catheterization (J11).
• Z442 selective coronary catheterization at the same sitting, the additional procedure paid at 50% (J9, J11).
• Z439 right heart catheterization at the same sitting, paid at 50% (J9).

Related codes: Z441, Z439, Z442, G297, G268, G296, G289

Source: Schedule of Benefits (July 1, 2026), Diagnostic and Therapeutic Procedures, Cardiovascular, page J9.

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