Summary & Overview
CPT 36254: Bilateral Selective Renal Artery Angiography
CPT code 36254 denotes bilateral selective catheter angiography of the renal arteries, a diagnostic, image-guided procedure used to visualize second- and higher-order branches of the main renal arteries via contrast injection. Nationally, this procedure is central to the evaluation of suspected renal artery stenosis, thrombosis, or other vascular causes of renal dysfunction and is commonly performed in hospital angiography suites and interventional radiology or catheterization labs.
Key payers discussed in this profile include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses clinical context, billing and service-line considerations, and payer-specific coverage patterns where available. Readers will find concise benchmarks, descriptions of typical sites of service, and the clinical scenarios that commonly justify use of the code. The profile also summarizes common modifiers and related service-line impacts for coding workflows; when payer-specific policies are applicable, the report highlights differences in prior authorization, documentation expectations, and bundling rules. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 36254 describes a diagnostic selective catheter angiography of the renal arteries. The provider inserts a catheter through an arterial access point at the groin (femoral artery), advances it into the main renal artery and its second-or-higher order branches supplying both kidneys, and injects radiographic contrast dye while acquiring X‑ray imaging to visualize the renal vasculature. The procedure is performed to investigate suspected renal artery stenosis, occlusion, thrombosis, or other vascular abnormalities affecting renal perfusion.
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Service type: Diagnostic catheter-based angiography of bilateral renal arteries
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Typical site of service: Hospital angiography suite or interventional radiology/cardiovascular catheterization lab
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with long-standing hypertension and progressive decline in renal function is referred for diagnostic evaluation of suspected renovascular disease. The patient reports worsening blood pressure control despite multi-drug therapy and an unexplained rise in serum creatinine. Noninvasive testing (renal duplex ultrasound and/or CT angiography) was inconclusive or contraindicated due to contrast allergy or impaired renal function, prompting an invasive angiographic evaluation.
The interventional radiologist or vascular surgeon performs 36254 via common femoral arterial access at the groin. A guide catheter is navigated under fluoroscopy into the abdominal aorta and then selectively into the main renal arteries. Contrast dye is injected into second- or higher-order branches of both renal arteries while digital subtraction angiography images are obtained to identify stenosis, occlusion, dissection, or thrombus. The procedure includes arterial catheter insertion, selective catheterization of bilateral renal arterial branches, and imaging documentation. Typical site of service is the hospital-based angiography suite or an outpatient endovascular/interventional radiology suite equipped for fluoroscopic vascular procedures. The clinical workflow includes pre-procedure history and consent, vascular access and catheter manipulation, image acquisition, immediate post-procedure hemostasis and monitoring, and documentation of findings with recommendations for further management such as medical therapy, angioplasty, or stenting if indicated.
Coding Specifications
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