Summary & Overview

CPT 34848: Fenestrated Endograft Repair of Visceral Aorta

CPT code 34848 represents a complex endovascular aortic repair using a fenestrated endograft to treat disease of the visceral aorta, with concurrent infrarenal endograft placement and four visceral artery endoprostheses. This procedure is used for anatomies involving the celiac, superior mesenteric, and renal arteries, and addresses challenging aneurysmal or dissection pathology that threatens visceral perfusion. Nationally, the code captures high-acuity vascular interventions with significant resource use and specialized device considerations.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, an explanation of typical sites of service and service type, and an overview of items commonly examined in reimbursement and policy reviews: coding intent, device and supply implications, and billing complexity. The publication highlights benchmarks and payment-policy levers relevant to complex endovascular aortic repairs, as well as operational considerations such as site-of-service designation and the impact of device configurations on coding. Data not available in the input will be indicated where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 34848fenestrated endograftendovascular aortic repairvisceral aortavascular surgeryinterventional radiologyendoprosthesisinfrarenal aortic graftcomplex aortic repair

Billing Code Overview

CPT code 34848 describes placement of a fenestrated endograft to repair the visceral aorta, performed under radiological guidance. The procedure includes deployment of a fenestrated endovascular graft in the upper abdominal aorta to accommodate the celiac, superior mesenteric, and renal arteries, placement of a one-piece or multiple-piece endograft in the infrarenal aorta, and placement of four additional visceral artery endoprostheses.

Service Type: Endovascular aortic repair with fenestrated endograft and visceral artery stenting

Typical Site of Service: Hospital inpatient or hospital outpatient interventional suite

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with a symptomatic thoracoabdominal aortic aneurysm involving the visceral segment presents with increasing abdominal pain and a known expanding aneurysm on surveillance imaging. Cross-sectional CT angiography demonstrates an infrarenal extension with involvement of the visceral aorta at the level of the celiac trunk, superior mesenteric artery (SMA), and both renal arteries. Endovascular repair with a fenestrated endograft is planned under radiologic guidance to exclude the aneurysm sac while preserving visceral perfusion. The procedure is performed in an interventional radiology or hybrid operating room environment with the patient under general anesthesia. Access is obtained via bilateral common femoral arterial cutdowns or percutaneous access. Under fluoroscopic and angiographic guidance, a fenestrated main aortic endograft is positioned to align fenestrations with the celiac, SMA, and renal ostia; an infrarenal aortic component is deployed as needed. Four additional visceral artery endoprostheses (branch stents) are advanced into the visceral vessels through the fenestrations and deployed to secure flow into each target artery. Completion angiography confirms exclusion of the aneurysm, patency of visceral branches, and absence of endoleak. Post-procedure care includes overnight intensive or step-down monitoring, serial vascular checks, and post-operative imaging per institutional protocol. Typical pre- and post-procedure documentation includes informed consent, operative report specifying 34848, device lot numbers, fluoroscopy time, blood loss estimate, and any adjunctive procedures or complications.

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	When two surgeons of different specialties work together as primary surgeons on distinct portions of the same procedure (e.g., vascular surgeon and cardiac surgeon collaborating on complex fenestrated repair).
`63`	Procedure performed on infants less than 4 kg	Not typically applicable; included only if patient meets weight criteria.
`66`	Surgical team	When a surgical team approach is utilized for a complex endovascular procedure requiring multiple attending surgeons under institutional policy.
`78`	Unplanned return to the operating/procedure room for related procedure during the global period	Use if patient requires an unplanned reintervention in the immediate postoperative period related to the initial repair.
`79`	Unrelated procedure or service during the postoperative period	Use if an unrelated procedure is performed during the global period (note: `79` is not in the provided list; therefore it is excluded).
`80`	Assistant surgeon	When a physician assistant or another surgeon assists and billing requires the assistant surgeon modifier (note: use of `80` varies by payer).
`62`	Two surgeons	(Duplicate entry removed — see first `62`)
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	When an advanced practice clinician performs documented assistant-at-surgery duties and payer permits billing with `AS`.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals	Use when the physician directs concurrent anesthesia care during the procedure.
`QX`	CRNA service with medical direction by a physician	Use when a Certified Registered Nurse Anesthetist provides anesthesia with physician medical direction.
`QY`	Medical direction of one CRNA by an anesthesiologist	Use when an anesthesiologist medically directs a CRNA for the procedure.
`26`	Professional component	Use when reporting only the physician professional component of a separately reportable radiology service tied to the procedure.
`TC`	Technical component	Use when reporting only the technical component of imaging or interpretation services related to the procedure.
`52`	Reduced services	When the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	When the procedure is started but discontinued due to extenuating circumstances or patient safety.

Taxonomy Code	Specialty	Notes
2080P0206X	Vascular Surgery	Primary specialty performing complex endovascular aortic repairs, including fenestrated endografts.
207R00000X	Interventional Radiology	Performs image-guided endovascular procedures and often leads fenestrated endograft placement in hybrid settings.
207L00000X	Cardiac Surgery	May participate for thoracoabdominal aortic procedures or when cardiothoracic expertise is required.
363L00000X	Vascular Neurology	Rarely involved; included only if cerebrovascular monitoring or neurologic specialty consultation is needed.
208800000X	General Surgery	May be involved in access management or hybrid open/endovascular approaches.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I71.4`	Abdominal aortic aneurysm, ruptured	Emergency indication for endovascular repair when the visceral aorta is involved and rupture occurs.
`I71.3`	Abdominal aortic aneurysm, without rupture	Elective or urgent indication for fenestrated endograft when aneurysm involves visceral segment.
`I71.2`	Thoracoabdominal aortic aneurysm, ruptured	Thoracoabdominal involvement requiring complex fenestrated repair if visceral branches are affected.
`I71.9`	Aortic aneurysm, unspecified	Used when documentation does not specify location but aortic aneurysm repair is performed.
`I77.4`	Other aneurysm of artery	Alternative vascular aneurysm diagnoses that may involve branches requiring endoprostheses.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`34848`	Fenestrated endovascular repair of the visceral aorta with placement of main fenestrated endograft and additional visceral artery endoprostheses	Primary procedure described — placement of fenestrated aortic endograft and four visceral branch stents.
`34701`	Endovascular repair of infrarenal aortic aneurysm; with modular bifurcated prosthesis	May be performed for infrarenal extension or as part of staged repair when modular components are required.
`36245`	Selective catheter placement, thoracic, abdominal aorta, each first order thoracic or abdominal aortogram	Diagnostic angiography or selective catheterization performed before or during the procedure to map visceral anatomy.
`36247`	Selective catheterization, selective catheter placement, visceral artery, each first-order branch, within abdominal aorta	Used when performing selective catheterization of visceral branches to facilitate branch stent placement.
`77012`	CT guidance for needle placement (eg, biopsy, aspiration, injection), radiological supervision and interpretation	May be billed for preprocedural CT-guided planning or intraoperative CT guidance in hybrid rooms (payor dependent).
`93010`	Electrocardiogram, routine ECG with interpretation and report	Common pre- and post-procedure monitoring and documentation; usually bundled but relevant for perioperative workflow.