Summary & Overview

CPT 36253: Selective Renal Arterial Angiography

CPT code 36253 denotes selective catheterization and angiographic imaging of a second- or higher-order subdivision of the main renal artery supplying a single kidney. It covers diagnostic renal arterial angiography performed via femoral arterial access to evaluate suspected stenosis, occlusion, aneurysm, or thromboembolic disease of the renal vasculature. Nationally, this procedure is a key diagnostic tool in the evaluation of renovascular hypertension, renal ischemia, and preoperative vascular assessment.

Key payers in the scope of practice and coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about when the procedure is performed, typical sites of service, and how the code fits into diagnostic vascular imaging workflows. The publication provides benchmarking and policy-focused content relevant to coverage and billing practice: common coding considerations, payer coverage patterns, and potential areas of claim scrutiny. Practical takeaways include how CPT code 36253 is used in clinical documentation, typical settings where the service is delivered, and issues that commonly affect reimbursement and prior authorization processes.

Data not available in the input for payer-specific rates and exact coverage criteria.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 36253renal angiographyselective renal catheterizationinterventional radiologydiagnostic vascular imagingrenal artery stenosisangiography codinghospital outpatient services

Billing Code Overview

CPT code 36253 describes selective catheterization of a second- or higher-order subdivision of the main renal artery supplying a single kidney for diagnostic angiography. The provider inserts a catheter through an arterial access point at the groin (femoral artery), maneuvers the catheter into the renal arterial branches, and injects radiographic contrast to visualize renal vasculature on X‑ray. The procedure is performed to investigate suspected blockages, stenosis, aneurysm, thrombus, or other vascular abnormalities of the renal blood supply.

Service type: Diagnostic vascular imaging procedure (selective renal arterial angiography)
Typical site of service: Hospital angiography suite or outpatient interventional radiology/cardiology suite (arterial access performed at the groin; imaging via fluoroscopy)

Data not available in the input for Associated Taxonomies, ICD‑10 Diagnoses, and Related Codes.

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with poorly controlled hypertension and declining renal function is referred for evaluation of suspected renovascular disease. The patient presents with resistant hypertension despite multi-drug therapy and an acute rise in serum creatinine. After noninvasive imaging (renal duplex ultrasound and CT/MR angiography) suggests a focal stenosis of the right renal artery, the interventional radiology team schedules a diagnostic selective renal artery angiography. The procedure involves percutaneous arterial access (commonly common femoral artery at the groin), advancement of a catheter into the ipsilateral renal artery, and selective catheterization into second- or higher-order branches of the main renal artery to inject contrast dye while obtaining fluoroscopic images.

The clinical workflow includes pre-procedure evaluation (consent, renal function assessment, coagulation status), vascular access and catheter manipulation under fluoroscopy, selective contrast injections to visualize the renal arterial tree, interpretation of angiographic findings for stenosis, dissection, aneurysm, or thrombus, and post-procedure monitoring for access site complications, contrast-related nephrotoxicity, and hemodynamic stability. If a hemodynamically significant lesion is identified, the team may plan a staged or immediate endovascular intervention such as angioplasty with or without stent placement, documented separately with appropriate therapeutic CPT codes.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier required/placeholder

Taxonomy Code	Specialty	Notes
`3356C0001X`	Interventional Radiology	Radiologists who perform endovascular diagnostic and therapeutic renal procedures.
`207RX0400X`	Vascular Surgery	Vascular surgeons may perform renal artery angiography and intervene endovascularly.
`2080P0207X`	Cardiology - Interventional Cardiology	Some interventional cardiologists trained in peripheral interventions perform visceral angiography including renal arteries.
`207L00000X`	Nephrology (procedural consult)	Nephrologists commonly refer and manage peri-procedural renal function but do not routinely perform the angiography.
`2085R0201X`	Diagnostic Radiology	Diagnostic radiologists involved in interpretation and image-guided access and imaging support.

ICD-10 Code	Description	Clinical Relevance
`I70.1`	Atherosclerosis of renal artery	Common cause of renal artery stenosis prompting selective renal angiography.
`I77.1`	Stricture of artery	Used when arterial narrowing is suspected in renal vasculature.
`I82.90`	Acute embolism and thrombosis of unspecified vein (site unspecified)	Relevant when thromboembolic disease of renal vasculature is considered (note: use appropriate arterial codes when arterial thrombosis suspected).
`N28.0`	Renal sclerosis, unspecified	May relate to chronic ischemic changes suspected from renovascular disease.
`N17.9`	Acute kidney failure, unspecified	Acute renal dysfunction prompting anatomic vascular evaluation when renovascular cause is suspected.
`I65.29`	Occlusion and stenosis of unspecified renal artery	Directly relevant when occlusion/stenosis of renal arterial supply is suspected.
`N26.9`	Unspecified contracted kidney, unspecified	Chronic ischemic kidney changes that may be evaluated with selective renal angiography.
`I74.8`	Embolism and thrombosis of other arterial vessels	Applied when arterial embolic disease possibly involves renal arteries and angiography is indicated.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36010`	Introduction of catheter, inferior vena cava, without radiological supervision and interpretation	Not typically directly related; listed for central venous catheterization when venous access is needed for concurrent procedures or monitoring.
`36245`	Selective catheter placement, renal, unilateral, initial second order or higher, with angiography (includes selective catheter placement and radiological supervision and interpretation)	A closely related code representing selective catheter placement to renal arteries; used when documenting initial selective catheter placement and angiography of the renal artery — may be reported in similar clinical contexts.
`36254`	Therapeutic transcatheter embolization or occlusion for renal artery branches (example)	Represents therapeutic endovascular procedures that may follow diagnostic angiography if intervention is required; billed separately when performed.
`37246`	Transcatheter placement of intravascular stent(s), each renal, with angioplasty when performed; percutaneous, each vessel	Used when percutaneous transluminal renal angioplasty and stent placement are performed during the same session following diagnostic angiography.
`74170`	CT angiography, abdomen, with contrast (including renal vasculature)	Often used in the diagnostic workup prior to invasive angiography; not billed on the same day with invasive angiography in some payer policies.
`96374`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intra-arterial infusion	May apply when intra-arterial medications are infused during or after angiography (e.g., vasodilators, thrombolytics), billed separately per guidelines.

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