Summary & Overview
CPT 37248: Transluminal Balloon Angioplasty of Vein, Open or Percutaneous
CPT code 37248 is a nationally recognized billing code for transluminal balloon angioplasty of a vein, excluding dialysis circuits. This minimally invasive procedure is performed to restore blood flow in venous structures, often addressing conditions such as peripheral vascular disease, atherosclerosis, or arterial embolism. The code encompasses both open and percutaneous approaches and includes all necessary imaging and radiological supervision and interpretation within the same vein.
Major payers covering this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The procedure is most commonly performed in outpatient hospital settings, reflecting its role in modern vascular care. Readers will gain insight into clinical indications, typical sites of service, and associated billing practices. The publication also highlights relevant modifiers, provider taxonomies, and related CPT and ICD-10 codes, offering a comprehensive overview of the procedural, clinical, and reimbursement landscape for 37248.
This summary provides a clear understanding of the scope and significance of CPT code 37248, equipping healthcare professionals, administrators, and policy analysts with essential information for benchmarking, policy review, and clinical context.
CPT Code Overview
CPT code 37248 describes a transluminal balloon angioplasty procedure performed on a vein, excluding dialysis circuits. This procedure can be conducted through open or percutaneous methods and includes all necessary imaging and radiological supervision and interpretation required to complete the angioplasty within the same vein. The service type is endovascular revascularization, typically performed in an outpatient hospital setting (Place of Service 22). This code is used to report interventions aimed at restoring blood flow in venous structures, addressing conditions such as vascular blockages or narrowing.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to the outpatient hospital setting with symptoms of peripheral vascular disease, such as intermittent claudication or limb pain. Diagnostic imaging reveals a venous stricture or atherosclerotic changes in the extremity veins. The vascular surgeon or cardiothoracic vascular surgeon performs a transluminal balloon angioplasty, either open or percutaneous, to restore blood flow. All necessary imaging and radiological supervision are included in the procedure. The workflow includes pre-procedure assessment, angioplasty, and post-procedure monitoring for complications.
Coding Specifications
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Modifier
51(Multiple Procedures): Used when more than one procedure is performed during the same session by the same provider. Indicates that the procedure is part of a group of multiple procedures. -
Modifier
59(Distinct Procedural Service): Used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. Indicates a distinct procedural service from others performed on the same day.
| Taxonomy Code | Specialty Name |
|---|---|
2086S0129X | Vascular Surgery Physician |
208C00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
208600000X | Surgery Physician |
These taxonomies represent providers specializing in vascular surgery, cardiothoracic vascular surgery, and general surgery, all of whom may perform the procedure described by CPT code 37248.
Related Diagnoses
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I70.219: Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity- Indicates narrowing of extremity arteries causing pain during exercise, relevant for angioplasty to restore blood flow.
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I70.92: Atherosclerosis of unspecified type of bypass graft(s) of the extremities- Refers to atherosclerotic changes in bypass grafts, which may require angioplasty if grafts become narrowed.
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I73.9: Peripheral vascular disease, unspecified- General diagnosis for vascular disease in the extremities, often leading to interventions like angioplasty.
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I74.3: Embolism and thrombosis of arteries of the lower extremities- Represents acute blockage of lower extremity arteries, which may be treated with angioplasty to restore patency.
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I77.1: Stricture of artery- Indicates abnormal narrowing of an artery, directly relevant to the need for angioplasty to relieve the stricture.
Related CPT Codes
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37246: Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation; initial artery.- Used when a stent is placed in an artery, often following angioplasty if vessel patency needs to be maintained.
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37249: Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation; each additional vein.- Used for stenting additional veins during the same session, commonly paired with angioplasty procedures.
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75710: Angiography, extremity, unilateral, radiological supervision and interpretation.- Used for diagnostic imaging of extremity vessels, often performed before or during angioplasty to guide intervention.
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36245: Selective catheter placement, arterial system; each first-order thoracic or brachiocephalic branch, within a vascular family.- Used for selective catheterization during endovascular procedures, may be necessary for access prior to angioplasty.
These codes are commonly used together in endovascular workflows, with angioplasty (37248) often followed by stenting (37246, 37249) and supported by imaging (75710) and catheter placement (36245).
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 37248 is $1,358.70 for Medicare, while the average commercial mean rate (BUCA) is $1,269.06. Blue Cross Blue Shield, Cigna, and UnitedHealth Group all have mean rates above the BUCA average, with UnitedHealth Group notably higher at $1,956.06.
Rate dispersion varies significantly across payers. Aetna has the tightest range between the 25th and 75th percentiles ($411.00), indicating less variability in contracted rates. UnitedHealth Group shows the widest dispersion ($965.00), reflecting greater variability in rates paid. The table and chart below present the full breakdown of national benchmarks for each payer.
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