Summary & Overview
CPT 36223: Imaging Supervision and Interpretation for Carotid/Cervicocerebral Angiography
CPT code 36223 denotes the imaging supervision and interpretation portion of catheter‑based angiography performed via a distal arterial approach to the thoracic aorta and into the common carotid or cervicocerebral arch to visualize intracranial or extracranial arteries. Nationally, this code is important for hospitals and imaging centers that provide diagnostic cerebrovascular angiography, separating the professional interpretation component from the technical procedure. Common payers included in national coverage and payment discussions are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. This publication provides a concise overview of clinical context and billing implications for CPT code 36223, outlines common payer coverage practices, and summarizes typical service settings and benchmarks. Readers will find a clear description of what CPT code 36223 represents, how it fits into cerebrovascular imaging workflows, and what to expect in terms of payer coverage patterns and coding considerations. Data not available in the input for specific reimbursement rates, associated taxonomies, and ICD‑10 diagnosis pairings are noted as unavailable where applicable.
Billing Code Overview
CPT code 36223 describes imaging supervision and interpretation for angiography performed by inserting a catheter through a distal artery into the thoracic aorta and advancing into the common carotid artery or cervicocerebral arch. The provider injects contrast material and obtains X‑ray images of intracranial or extracranial arteries or of the cervicocerebral arch to evaluate vascular disease. This code represents only the imaging supervision and interpretation component of the procedure.
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Service type: Imaging supervision and interpretation for catheter‑based carotid/cervicocerebral angiography
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Typical site of service: Hospital radiology department or outpatient imaging center where catheter‑based angiography is performed
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with sudden onset right-sided weakness and expressive aphasia presents to the emergency department. Neurovascular team activation occurs for suspected acute ischemic stroke. After non-contrast CT rules out hemorrhage, the interventional radiology (IR) team performs catheter angiography with catheter access via a distal artery (commonly the femoral artery) advanced into the thoracic aorta and selectively into the common carotid artery or cervicocerebral arch. Contrast injections are performed while the physician provides imaging supervision and interpretation of the angiographic runs to evaluate for large vessel occlusion, tandem lesions, carotid stenosis, intracranial aneurysm, or vascular malformation.
The clinical workflow includes: pre-procedure consent and assessment, vascular access and catheter navigation by the proceduralist, acquisition of fluoroscopic angiographic images with contrast injections, and real-time interpretation by the imaging physician. For billing purposes, 36223 is reported when only the imaging supervision and interpretation component for selective catheter angiography of the common carotid artery or cervicocerebral arch is performed and documented, separate from the technical or catheter placement components if billed by another entity or facility. Typical site of service is an acute care hospital angiography suite, dedicated neurointerventional suite, or interventional radiology/cardiac catheterization lab.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |