Summary & Overview
CPT 36225: Selective Subclavian/Innominate Artery Angiography, Imaging Interpretation
CPT code 36225 denotes imaging supervision and interpretation for selective angiography of the subclavian or innominate arteries with evaluation of ipsilateral vertebral circulation or the cervicocerebral arch. This code documents diagnostic catheter-based angiography performed by advancing a catheter through a distal artery into the thoracic aorta and internal carotid artery before selectively engaging the target arch vessels. Its use is important for diagnosing cerebrovascular and upper extremity arterial disease and for guiding subsequent endovascular or surgical management.
Key national payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and which payers commonly reimburse for catheter-based diagnostic angiography. The publication provides benchmarks related to utilization and billing patterns, summaries of pertinent policy updates affecting documentation and medical necessity, and coding guidance that clarifies the clinical scenarios in which this code applies. The material is intended for billing professionals, radiology and vascular specialists, and revenue integrity teams seeking a national overview of coding and payer considerations for selective subclavian/innominate angiography.
Billing Code Overview
CPT code 36225 describes imaging supervision and interpretation for diagnostic angiography performed by advancing a catheter through a distal artery into the thoracic aorta and internal carotid artery, then selectively into the subclavian or innominate artery. Contrast material is injected to obtain X‑ray images of the subclavian or innominate arteries and the ipsilateral vertebral circulation or of the cervicocerebral arch to detect vascular disease.
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Service type: Diagnostic vascular angiography with selective catheterization of the subclavian/innominate arteries and ipsilateral vertebral circulation
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Typical site of service: Hospital angiography suite or outpatient/endovascular procedure center
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a history of hypertension and transient ischemic attack presents with new-onset vertebrobasilar symptoms including dizziness and transient visual disturbance. Noninvasive imaging (CTA/MRA) suggests high-grade stenosis of the proximal subclavian artery with possible compromise of ipsilateral vertebral flow. The vascular interventional team schedules a diagnostic and potential therapeutic catheter angiography.
In the angiography suite, an arterial sheath is placed in a distal artery (commonly the femoral or radial artery). A catheter is navigated into the thoracic aorta, then selectively into the internal carotid and advanced into the subclavian or innominate artery for targeted contrast injections. Real-time fluoroscopic imaging is performed while contrast is injected to visualize the subclavian or innominate arteries and the ipsilateral vertebral circulation or cervicocerebral arch. The provider performs imaging supervision and interpretation, documents findings (stenosis, occlusion, dissection, collateral flow), and may coordinate same-session endovascular intervention if indicated. Typical monitoring includes hemodynamic assessment, access-site management, and post-procedure neurologic checks. Typical site of service is an outpatient or inpatient angiography/interventional radiology or vascular surgery suite within a hospital or ambulatory surgical center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Professional component |