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    v1.0.28
    OpenPayerBilling CodesDiagnostic Studies of Cervicocerebral ArteriesCPT cpt-36228-intracranial-branch-angiography-add-on-imaging
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    CPT 36228: Intracranial Branch Angiography Imaging Supervision and Interpretation

    Medicare pays $1604 on average nationally for this procedure.

    CPT code 36228 is an add-on imaging supervision and interpretation code for angiography when a catheter is inserted into additional branches of the intracranial subdivisions of the internal carotid or vertebral arteries during the same session; it describes performing angiography of intracranial circulation such as the middle cerebral artery and posterior inferior cerebellar artery in addition to angiography of the internal carotid or common carotid artery. Service type: angiographic imaging supervision and interpretation. Typical site of service: hospital angiography suite or interventional radiology/catheterization lab.

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

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient presents with sudden-onset severe headache and focal neurologic deficits. Noncontrast head CT excludes large hemorrhage, and CT angiography demonstrates a suspected intracranial aneurysm in the middle cerebral artery (MCA) distribution. The neurointerventional team schedules diagnostic cerebral angiography with possible endovascular treatment. During the procedure the interventional neuroradiologist obtains arterial access (commonly femoral or radial), advances a catheter into the internal carotid artery, and performs angiography of the carotid circulation. To fully evaluate the MCA and posterior inferior cerebellar artery (PICA) branches, the physician places additional microcatheters into intracranial subdivisions of the internal carotid and vertebral arteries and performs focused branch angiography with live fluoroscopic imaging and documentation. The service billed with 36228 is an add-on code for imaging supervision and interpretation when separate catheterizations of additional intracranial branches (for example MCA and PICA) are performed during the same session. Typical site of service is an inpatient or outpatient hospital-based angiography suite or an ambulatory surgical center with full neurointerventional capabilities. Workflow includes pre-procedure consent and history review, vascular access and catheter placement by the primary operator, imaging supervision and interpretation by the billing physician for the additional intracranial branch angiograms, intraprocedural documentation, and post-procedure angiographic review with contrast runs archived in the PACS.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    36215Selective catheter placement, intracranial, for diagnostic angiography, each first order intracranial branch, when performedOften performed prior to or in conjunction with 36228 as the primary selective catheterization of a principal intracranial branch
    36216Selective catheter placement, intracranial, each second order intracranial branchMay be billed for additional selective catheterizations; 36228 is an add-on for imaging supervision/interpretation of additional branches during same session
    36245Selective catheter placement, vertebral artery, intracranialUsed when vertebral/posterior circulation catheterization is performed in same session as carotid angiography; complements 36228 when PICA or other posterior branches are catheterized
    36226Selective catheter placement, internal carotid artery, intracranial, first order; initial diagnostic catheterizationRepresents primary intracranial ICA catheterization that often precedes the add-on imaging supervision coded by 36228
    75774Angiography, head or neck, including radiological supervision and interpretation; bilateral, without catheter-axis rotational angiographyDiagnostic angiographic interpretation code that may be reported by the imaging physician when documentation supports separate reporting alongside catheter codes

    Related Modifiers

    8 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…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RG0100XGastroenterology PhysicianAn internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This…
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    2080N0001XNeonatal-Perinatal Medicine PhysicianA pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with…
    102L00000XPsychoanalystPsychoanalysis is a comprehensive, theoretical framework which, when applied to a treatment process, consists of an intensive verbal, therapeutic rela…
    176B00000XMidwifeA Midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized c…
    363LC0200XCritical Care Medicine Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    2084N0400XNeurology PhysicianA Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, auton…

    Related Payer Policy Updates

    Specialty: Neurology/Neurosurgery1 / 3

    7 rows

    PolicyPayerEffective Date
    Artificial Cervical Intervertebral Discuniverahealthcare2026-10-15
    Lumbar Microdiscectomyuniverahealthcare2026-10-15
    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

    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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