CPT 37182 TIPS Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 37182: TIPS Creation with Stent for Portal Hypertension

CPT code 37182 represents transjugular intrahepatic portosystemic shunt (TIPS) creation with stent placement to establish a channel between the portal vein and a hepatic vein for treatment of portal hypertension. This procedure is clinically significant nationwide because it directly addresses life‑threatening complications of portal hypertension, including variceal bleeding and refractory ascites, and often requires coordination across interventional radiology, hepatology, and hospital services. Payers commonly involved in coverage and reimbursement for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and service context, national benchmarking and payment considerations for major payers, and notes on documentation and site‑of‑service implications. The publication provides a concise policy and billing reference covering expected settings of care, typical utilization drivers, and what to expect in payer coverage patterns. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare37182CPTtransjugular intrahepatic portosystemic shuntinterventional radiologyportal hypertensionstent placementinpatientoutpatientvascular intervention

Billing Code Overview

CPT code 37182 describes creation of an artificial channel (tunnel) between the portal vein and a hepatic vein with placement of a stent to treat portal hypertension. The procedure is performed to lower portal venous pressure and reduce the risk of serious gastrointestinal bleeding from varices in the stomach and esophagus.

Service type: Transjugular intrahepatic portosystemic shunt (TIPS) creation with stent placement
Typical site of service: Inpatient or outpatient interventional radiology suite within a hospital setting

Clinical & Coding Specifications

Clinical Context

A typical patient is a 52-year-old with decompensated cirrhosis and recurrent variceal bleeding due to portal hypertension. The patient presents with melena and hypotension despite endoscopic therapy and medical management. After stabilization in interventional radiology and multidisciplinary review, the interventional radiologist performs a transjugular intrahepatic portosystemic shunt (TIPS) creation with stent placement to decompress the portal system.

The clinical workflow: initial evaluation includes laboratory tests (CBC, coagulation panel, liver function tests), cross-sectional imaging (contrast-enhanced CT or Doppler ultrasound) to evaluate hepatic vasculature, informed consent, and pre-procedure anesthesia assessment. In the angiography suite, access is obtained (typically via right internal jugular vein), a transhepatic tunnel is created between a portal vein branch and a hepatic vein, portal and systemic pressures are measured, and a covered stent is deployed. Post-procedure monitoring includes hemodynamic observation, hepatic encephalopathy surveillance, Doppler ultrasound to confirm flow through the shunt, and follow-up imaging and clinic visits for variceal bleeding prevention and stent patency assessment.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician professional component separate from a technical component billed by the facility or radiology group.

CPT 37140: Portocaval Shunt for Portal Hypertension

CPT-37183-TIPS-SHUNT-REVISION-STENT-PLACEMENT

CPT 37183: TIPS Shunt Revision with Stent Placement

CPT-37180-PROXIMAL-SPLENORENAL-VENOUS-ANASTOMOSIS

CPT 37180: Proximal Splenorenal Venous Anastomosis

CPT-37145-RENOPORTAL-VENOUS-ANASTOMOSIS-RENAL-TO-PORTAL-VEIN

CPT 37145: Renoportal Venous Anastomosis, Renal-to-Portal Vein

CPT-37160-CAVAL-MESENTERIC-VENOUS-ANASTOMOSIS-PORTAL-HYPERTENSION

CPT 37160: Caval–Mesenteric Venous Anastomosis for Portal Hypertension

CPT-37181-SPLENORENAL-SHUNT-OPEN-SURGICAL-VENOUS-BYPASS

CPT 37181: Splenorenal Shunt, Open Surgical Venous Bypass

Taxonomy Code	Specialty	Notes
2084P0805X	Interventional Radiology	Primary specialty performing TIPS procedures in most centers.
2086S0121X	Vascular and Interventional Radiology	Alternate taxonomy used for physicians focusing on vascular interventions.
207K00000X	Surgery - General	General surgeons with vascular expertise may be involved in hybrid or surgical shunt management.
208000000X	Diagnostic Radiology	Diagnostic radiologists involved in imaging guidance and pre/post procedural interpretation.
207LX0004X	Transplant Hepatology	Hepatologists involved in patient selection and peri-procedural management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K76.6`	Portal hypertension	Primary indication for TIPS to decompress portal venous pressure and prevent variceal bleeding.
`I85.01`	Esophageal varices with bleeding	TIPS is used when variceal bleeding is recurrent or refractory to endoscopic therapy.
`I85.11`	Secondary esophageal varices without bleeding	Preventive indication for TIPS in selected high-risk patients.
`K72.90`	Hepatic failure, unspecified, without coma	Advanced liver disease often coexists with portal hypertension and may influence candidacy and risk.
`K74.60`	Unspecified cirrhosis of liver	Underlying cirrhosis is the most common cause of portal hypertension requiring TIPS.
`K76.89`	Other specified diseases of liver	Includes portal vein thrombosis or other hepatic vascular disorders that may necessitate TIPS.
`I82.99`	Other venous embolism and thrombosis of other sites	Portal vein thrombosis may complicate portal hypertension management and affect TIPS planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`74240`	Fluoroscopic guidance for vascular procedures, intraprocedural monitoring	Used during TIPS for imaging guidance and pressure measurements.
`76937`	Ultrasound guidance for vascular access	Used when ultrasound guidance is employed for venous access (internal jugular) or portal vein localization.
`36215`	Selective catheter placement, venous system; each first order thoracic, abdominal, or pelvic vein, unilateral	May be used for portal venography or selective catheterization during portal pressure measurement.
`36415`	Collection of venous blood by venipuncture	Used for pre-procedure laboratory testing; often billed by the lab or facility.
`43320`	Transjugular intrahepatic portosystemic shunt (alternative coding reference)	Data not available in the input.

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