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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.

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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.

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CPT 36253: Selective Renal Arterial Angiography

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

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Sign up for cpt 36253 policy alerts

Get alerted when payer policies referencing 36253 are released or updated.

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Billing Code Overview

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	Not typically appended; present in raw list as placeholder.
`11`	Office/Outpatient Visit (facility-specific usage)	Use per payer if designated for primary service in certain billing systems when required by payor rules.
`22`	Increased procedural services	When the procedure requires substantially greater work than usual (extensive technical difficulty, prolonged fluoroscopy) — documentation must support.
`23`	Unusual anesthesia — medically necessary	Use if procedure performed under general anesthesia for documented medical necessity beyond typical conscious sedation.
`50`	Bilateral procedure	If bilateral renal selective catheterizations are performed and payer requires bilateral modifier (note: many vascular CPTs are unilateral; verify payer policy).
`51`	Multiple procedures	When additional unrelated procedures are performed during the same session; lists secondary procedures as reduced payment may apply.
`52`	Reduced services	When the procedure is partially reduced or not completed as planned (e.g., limited angiography due to contrast allergy) — documentation of limitation required.
`59`	Distinct procedural service	When another procedure performed at the same session is distinct and separate from the renal angiography (e.g., separate vascular territory); use to identify separate services per payer rules.
`62`	Two surgeons	When two surgeons from different specialties perform distinct portions requiring co-surgery; rare for diagnostic angiography but applicable if applicable.
`76`	Repeat procedure by same physician (note: not in raw list)	Data not available in the input.

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.

Related Diagnoses

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.

CPT 36245: Selective Arterial Catheterization for Angiography

CPT-36246-SELECTIVE-CATHETER-PLACEMENT-SECOND-ORDER-ABDOMINAL-PELVIC-LOWER-EXTREMITY

CPT 36246: Selective Catheter Placement in Second-Order Abdominal/Pelvic/LE Artery Branch

CPT-36247-SELECTIVE-CATHETERIZATION-THIRD-ORDER-ABDOMINAL-PELVIC-LOWER-EXTREMITY

CPT 36247: Selective Catheterization for Third‑Order Abdominal/Pelvic/Lower Extremity Artery

CPT-36248-SELECTIVE-ADDITIONAL-ARTERY-BRANCH-ANGIOGRAPHY

CPT 36248: Selective Additional Arterial Branch Angiography

CPT-36251-SELECTIVE-RENAL-ARTERIOGRAPHY-GROIN-ACCESS

CPT 36251: Selective Renal Arteriography via Femoral Access

CPT-36252-BILATERAL-SELECTIVE-RENAL-ANGIOGRAPHY

CPT 36252: Bilateral Selective Renal Angiography

CPT-36254-RENAL-ARTERY-SELECTIVE-ANGIOGRAPHY-BILATERAL

CPT 36254: Bilateral Selective Renal Artery Angiography

CPT-36260-INTRA-ARTERIAL-CATHETER-WITH-SUBCUTANEOUS-INFUSION-PUMP

CPT 36260: Intra-arterial Catheter with Subcutaneous Infusion Pump

CPT-36261-REVISION-IMPLANTABLE-CATHETER-INFUSION-PUMP

CPT 36261: Revision of Implanted Catheter and Infusion Pump

CPT-36262-INFUSION-PUMP-AND-CATHETER-EXPLANTATION-OPEN

CPT 36262: Removal of Implanted Infusion Pump and Catheter

Showing 1–10 of 11

References

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.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.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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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier required/placeholder	Not typically appended; present in raw list as placeholder.
`11`	Office/Outpatient Visit (facility-specific usage)	Use per payer if designated for primary service in certain billing systems when required by payor rules.
`22`	Increased procedural services	When the procedure requires substantially greater work than usual (extensive technical difficulty, prolonged fluoroscopy) — documentation must support.
`23`	Unusual anesthesia — medically necessary	Use if procedure performed under general anesthesia for documented medical necessity beyond typical conscious sedation.
`50`	Bilateral procedure	If bilateral renal selective catheterizations are performed and payer requires bilateral modifier (note: many vascular CPTs are unilateral; verify payer policy).
`51`	Multiple procedures	When additional unrelated procedures are performed during the same session; lists secondary procedures as reduced payment may apply.
`52`	Reduced services	When the procedure is partially reduced or not completed as planned (e.g., limited angiography due to contrast allergy) — documentation of limitation required.
`59`	Distinct procedural service	When another procedure performed at the same session is distinct and separate from the renal angiography (e.g., separate vascular territory); use to identify separate services per payer rules.
`62`	Two surgeons	When two surgeons from different specialties perform distinct portions requiring co-surgery; rare for diagnostic angiography but applicable if applicable.
`76`	Repeat procedure by same physician (note: not in raw list)	Data not available in the input.

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.

Related Diagnoses

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.

CPT 36245: Selective Arterial Catheterization for Angiography

CPT-36246-SELECTIVE-CATHETER-PLACEMENT-SECOND-ORDER-ABDOMINAL-PELVIC-LOWER-EXTREMITY

CPT 36246: Selective Catheter Placement in Second-Order Abdominal/Pelvic/LE Artery Branch

CPT-36247-SELECTIVE-CATHETERIZATION-THIRD-ORDER-ABDOMINAL-PELVIC-LOWER-EXTREMITY

CPT 36247: Selective Catheterization for Third‑Order Abdominal/Pelvic/Lower Extremity Artery

CPT-36248-SELECTIVE-ADDITIONAL-ARTERY-BRANCH-ANGIOGRAPHY

CPT 36248: Selective Additional Arterial Branch Angiography

CPT-36251-SELECTIVE-RENAL-ARTERIOGRAPHY-GROIN-ACCESS

CPT 36251: Selective Renal Arteriography via Femoral Access

CPT-36252-BILATERAL-SELECTIVE-RENAL-ANGIOGRAPHY

CPT 36252: Bilateral Selective Renal Angiography

CPT-36254-RENAL-ARTERY-SELECTIVE-ANGIOGRAPHY-BILATERAL

CPT 36254: Bilateral Selective Renal Artery Angiography

CPT-36260-INTRA-ARTERIAL-CATHETER-WITH-SUBCUTANEOUS-INFUSION-PUMP

CPT 36260: Intra-arterial Catheter with Subcutaneous Infusion Pump

CPT-36261-REVISION-IMPLANTABLE-CATHETER-INFUSION-PUMP

CPT 36261: Revision of Implanted Catheter and Infusion Pump

CPT-36262-INFUSION-PUMP-AND-CATHETER-EXPLANTATION-OPEN

CPT 36262: Removal of Implanted Infusion Pump and Catheter

Showing 1–10 of 11

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.