Summary & Overview
CPT 34845: Fenestrated Endograft Repair of Visceral Aorta with Single Visceral Artery Endoprosthesis
CPT code 34845 covers a complex endovascular procedure: placement of a fenestrated endograft in the visceral aorta with an additional endoprosthesis placed in a single visceral artery. This code captures advanced, image-guided repair of the upper abdominal aorta when critical branch vessels (celiac, superior mesenteric, renal arteries) require preservation or incorporation into the repair. Nationally, the code represents high-acuity vascular care often performed in tertiary centers with hybrid operating rooms and specialized interventional teams.
Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of reimbursement benchmarks, common billing and documentation considerations, and the clinical context for when fenestrated endografts are used versus alternative open or standard endovascular repairs. The summary highlights policy and coding considerations that affect coverage and prior authorization processes, and it outlines the procedural elements codified by 34845 that clinicians and billers must document to support appropriate coding. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 34845 describes placement of a fenestrated endograft under radiological guidance to repair the visceral aorta (the upper abdominal aorta involving the celiac, superior mesenteric, and renal arteries). The procedure includes placement of either a single-piece or multi-piece endograft in the infrarenal aorta, with placement of an additional endoprosthesis in a single visceral artery.
Service type: Endovascular aortic repair with fenestrated endograft placement (complex endovascular vascular intervention).
Typical site of service: Hospital-based interventional radiology or vascular surgery suite, frequently performed in an operating room or hybrid operating room with fluoroscopic imaging and endovascular capabilities.
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with a symptomatic juxtarenal abdominal aortic aneurysm involving the visceral segment (involving the celiac, superior mesenteric, and renal arteries) is scheduled for endovascular repair. Under general anesthesia in a hybrid operating room with full fluoroscopic and radiologic support, the vascular surgery and interventional radiology team perform fenestrated endovascular aortic repair (FEVAR). Using radiologic guidance, the provider deploys a fenestrated endograft in the visceral aorta and an infrarenal modular endograft component below the renal arteries. An additional covered stent (endoprosthesis) is placed into a single visceral artery (for example, the left renal artery) through the fenestration to preserve perfusion. Intraoperative steps include arterial access via common femoral artery cutdown or percutaneous access, aortography to map anatomy, precise orientation and deployment of the fenestrated device, cannulation of the target visceral artery, placement of the branch stent, and completion angiography to confirm exclusion of the aneurysm sac and branch patency. Typical postoperative workflow includes recovery in a monitored setting, vascular access site assessment, serial hemoglobin checks, renal function monitoring, and follow-up CT angiography before discharge or at 30 days to assess endograft position and detect endoleak.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or complexity significantly exceeds typical for the procedure (document justification). |