CPT 37184 Endovascular Thrombectomy Reimbursement | OpenPayer

Summary & Overview

CPT 37184: Endovascular Thrombectomy with Catheter-Directed Thrombolysis

CPT code 37184 represents an endovascular procedure combining mechanical thrombectomy and catheter-directed pharmacologic thrombolysis to re-establish flow in a noncoronary, non–intracranial arterial occlusion or arterial bypass graft. This intervention is clinically significant for limb- and graft-saving care and carries implications for hospital resource use, interventional radiology and vascular surgery practice patterns, and national reimbursement policy. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical procedure and service setting, an overview of payer coverage considerations, common billing modifiers and coding context, and links to related codes and guidance where available. The publication summarizes typical site-of-service patterns, coding nuances for initial-vessel treatment, and what claim reviewers commonly evaluate for medical necessity and documentation completeness. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare37184CPTendovascular thrombectomycatheter-directed thrombolysisinterventional radiologyvascular surgeryfluoroscopyhospital outpatientinpatient procedures

Billing Code Overview

CPT code 37184 describes a combined mechanical thrombectomy with pharmacologic thrombolytic injection to treat an occlusion in a noncoronary, non–intracranial artery or an arterial bypass graft. The provider performs mechanical removal of thrombus under fluoroscopic guidance and administers a thrombolytic agent into the target vessel. Use of this code applies when the procedure is performed on the initial vessel.

Service type: Endovascular arterial thrombectomy with catheter-directed thrombolysis
Typical site of service: Hospital inpatient or hospital outpatient interventional radiology/cardiovascular suite or hybrid operating room

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old with sudden onset of worsening unilateral lower extremity pain, pallor, and absent distal pulses after presentation to the emergency department. The vascular surgery and interventional radiology teams evaluate the patient and establish acute limb ischemia due to an occlusive thrombus in the femoral-popliteal arterial segment or in an arterial bypass graft. Imaging with duplex ultrasound and CT angiography localizes the occlusion. The patient is taken to an interventional angiography suite where, under fluoroscopic guidance, the operator performs combined mechanical thrombectomy and catheter-directed thrombolytic infusion of tissue plasminogen activator into the affected noncoronary peripheral artery. Procedural steps include arterial access (typically common femoral), catheter and guidewire navigation to the occlusion, mechanical clot disruption/aspiration with a thrombectomy device, selective infusion of thrombolytic agent, fluoroscopic monitoring, and completion angiography to confirm flow restoration. Post-procedure the patient is monitored in a step-down or intensive care setting for reperfusion, bleeding, and hemodynamic stability, with anticoagulation and vascular surgery follow-up arranged as indicated.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician’s interpretive or professional portion if a separate technical component is billed.

CPT 37186: Endovascular Removal of Thrombus or Embolus, Peripheral Artery

CPT-37185-ADD-ON-ENDOVASCULAR-THROMBECTOMY-COMBINED-TECHNIQUE

CPT 37185: Add-On Endovascular Thrombectomy, Mechanical Plus Thrombolytic

Taxonomy Code	Specialty	Notes
208000000X	Vascular Surgery	Primary specialty performing peripheral arterial thrombectomy and bypass graft interventions.
207RP1001X	Interventional Radiology	Frequently performs image-guided mechanical thrombectomy and catheter-directed thrombolysis.
208VP0002X	Cardiovascular Surgery	May perform peripheral arterial interventions, particularly graft salvage.
208D00000X	General Surgery	Performs vascular procedures in some centers, often in collaboration with vascular specialists.
207K00000X	Diagnostic Radiology	Provides fluoroscopic guidance and interpretation support during the procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Primary indication for mechanical thrombectomy and thrombolysis in acute limb ischemia.
`I74.01`	Embolism and thrombosis of right femoral artery	Locates the occlusion to a specific vessel treated with endovascular thrombectomy.
`I74.02`	Embolism and thrombosis of left femoral artery	Locates the occlusion to a specific vessel treated with endovascular thrombectomy.
`I74.8`	Embolism and thrombosis of other specified arteries	Applies when occlusion involves peripheral arteries not otherwise classified (e.g., popliteal).
`I97.1`	Postprocedural thrombosis of an artery	Relevant when treating thrombosis occurring in arterial bypass grafts or post-op vessels.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36200`	Introduction of catheter, aorta, via brachial or femoral artery; diagnostic, initial vessel	Often performed prior to therapeutic intervention to obtain diagnostic angiography and vascular access.
`75989`	Radiological supervision and interpretation, for other procedure (e.g., catheter-directed infusion)	Used for fluoroscopic supervision and interpretation associated with catheter-directed thrombolytic infusion.
`37186`	Transcatheter therapy, arterial, percutaneous; thrombectomy, other than central nervous system, single vessel (separate code for mechanical thrombectomy alone)	Performed when mechanical thrombectomy is done without combined pharmacologic thrombolytic injection or for subsequent vessels.
`36000`	Arterial puncture, percutaneous, for diagnostic or therapeutic purposes; without sheath/catheter	May be reported for arterial access in certain billing contexts if separate from main procedure reporting.
`37226`	Revascularization, endovascular, open or percutaneous; transluminal balloon angioplasty, percutaneous, non-coronary artery	Often performed adjunctively for residual stenosis after thrombectomy and thrombolysis.

OpenPayer