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    v1.0.28
    OpenPayerBilling CodesDiagnostic Studies of Cervicocerebral ArteriesCPT cpt-36227-external-carotid-angiography-imaging-supervision-interpretation
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    CPT 36227: External Carotid Artery Angiography Imaging Supervision

    Medicare pays $281 on average nationally for this procedure.

    CPT code 36227 is an add-on imaging supervision and interpretation service for angiography when a catheter is inserted into the external carotid artery during the same session as angiography of the internal carotid, common carotid, or innominate artery; service type: angiographic imaging supervision and interpretation, add-on procedure; typical site of service: hospital-based or outpatient angiography suite / interventional radiology where catheter-based cerebral or head and neck angiography is performed.

    For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient with symptomatic carotid artery disease undergoes diagnostic cerebral angiography to evaluate a suspected stenosis of the internal carotid artery after duplex ultrasound and CT angiography raise concern. During the same session, the interventional radiologist places a catheter in the common carotid artery and performs angiography of the internal carotid artery. Because additional imaging of external carotid artery branches is required to delineate collateral supply and potential embolic sources, the provider advances a catheter into the external carotid artery and performs selective angiography while supervising and interpreting the imaging. The procedure occurs in an outpatient angiography suite or hospital catheterization lab under conscious sedation or general anesthesia depending on patient comorbidities. The imaging supervision and interpretation for the external carotid artery angiography is reported in addition to the primary angiographic catheter placements using add-on code 36227 when performed in the same session as angiography of the internal carotid, common carotid, or innominate artery. Procedural documentation includes indication, arterial access site, catheters used, vessels imaged, contrast volumes, fluoroscopy time, findings, interpretation, and any immediate complications and management.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    36215Selective catheter placement, internal carotid artery, unilateral; initial vesselOften performed immediately prior to or with 36227 when accessing and imaging the internal carotid artery in the same session; serves as the primary selective carotid catheter placement.
    36216Selective catheter placement, internal carotid artery, unilateral; each additional vesselMay be reported for additional selective catheterizations of internal carotid branches when more than one internal carotid vessel is catheterized during the session.
    36222Selective catheter placement, common carotid artery, unilateralUsed when selective catheter placement in the common carotid artery is performed in the same session; 36227 is an add-on for external carotid imaging in addition to internal/common carotid angiography.
    36220Selective catheter placement, innominate artery, unilateralReported for catheter placement and angiography of the innominate artery when performed in the same session as external carotid angiography reported with 36227.
    36228Catheter placement, external carotid artery, initial vessel (hypothetical related code)Not provided in input; Data not available in the input.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    207RP1001XPulmonary Disease PhysicianAn internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational an…
    2086S0105XSurgery of the Hand (Surgery) PhysicianA surgeon with expertise in the investigation, preservation and restoration by medical, surgical and rehabilitative means, of all structures of the up…
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    246QC2700XCytotechnology Specialist/TechnologistTechnologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Pathology
    156FC0800XContact Lens Technician/TechnologistAn optician or other ancillary support staff person who, where authorized by state law and trained or certified to do so, may fit or dispense contact …
    163WR0006XRegistered Nurse First AssistantA perioperative registered nurse who works in collaboration with the surgeon and other health care team members to achieve optimal outcomes. The RNFA…

    Related Payer Policy Updates

    Specialty: Neurology/Neurosurgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Lumbar Microdiscectomyuniverahealthcare2026-10-15
    Artificial Cervical Intervertebral Discuniverahealthcare2026-10-15
    Lumbar Decompressionuniverahealthcare2026-10-15
    Nerve Fiber Density Testing (IENFD/ENFD) Coverage CriteriaOscar Health2026-10-01
    Biomarker Testing for Multiple Sclerosis and Related Neurologic DiseasesOscar Health2026-10-01
    Biochemical Markers of Alzheimer Disease and DementiaOscar Health2026-10-01
    Serum Testing For Evidence of Mild Traumatic Brain InjuryOscar Health2026-10-01
    Evaluation of Cerebrospinal Fluid, Urine and Plasma for Alzheimer DiseaseBluecross Idaho2026-09-01
    Prior Authorization of Spinal ProceduresBlue Cross Blue Shield - Rhode Island2026-09-01
    Alzheimer's Disease - Amyloid Beta- Directed Antibodies - KisunlaCigna2026-08-15

    Related Codes

    CPT-36200-AORTIC-CATHETERIZATION-DISTAL-ARTERIAL-ACCESS

    CPT 36200: Arterial Catheterization for Aortography or Pressure Measurement

    CPT-36215-SELECTIVE-CATHETERIZATION-THORACIC-BRACHIOCEPHALIC-BRANCH

    CPT 36215: Catheter Advancement into First-Order Thoracic/Brachiocephalic Branches

    CPT-36216-SELECTIVE-SECOND-ORDER-THORACIC-BRACHIOCEPHALIC-ANGIOGRAPHY

    CPT 36216: Catheterization of Second-Order Thoracic/Brachiocephalic Branch

    CPT-36217-SELECTIVE-THIRD-ORDER-THORACIC-BRACHIOCEPHALIC-ANGIOGRAPHY

    CPT 36217: Selective Catheterization of Third-Order Thoracic/Brachiocephalic Branches

    CPT-36218-SELECTIVE-CATHETERIZATION-THORACIC-BRACHIOCEPHALIC-BRANCH-ANGIOGRAPHY

    CPT 36218: Selective Catheterization of Additional Thoracic/Brachiocephalic Branch

    CPT-36221-THORACIC-AORTIC-ANGIOGRAPHY-IMAGING-SUPERVISION-INTERPRETATION

    CPT 36221: Thoracic Aortic Catheter Angiography, Imaging Supervision

    CPT-36222-CAROTID-CERVICOCEREBRAL-ANGIOGRAPHY-IMAGING-INTERPRETATION

    CPT 36222: Cerebral/Carotid Angiography via Distal Arterial Catheterization

    CPT-36223-CAROTID-CERVICOCEREBRAL-ANGIOGRAPHY-IMAGING-INTERPRETATION

    CPT 36223: Imaging Supervision for Carotid/Cervicocerebral Angiography

    CPT-36224-INTERNAL-CAROTID-ARTERY-ANGIOGRAPHY-IMAGING

    CPT 36224: Diagnostic Catheter Angiography of Internal Carotid/Cervicocerebral Arteries

    CPT-36225-SUBCLAVIAN-INNOMINATE-ARTERY-ANGIOGRAPHY-INTERPRETATION

    CPT 36225: Subclavian/Innominate Artery Angiography with Vertebral Circulation Imaging

    Showing 1–10 of 12

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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