CPT 37185 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

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

CPT code 37185 defines an add-on endovascular procedure for treating additional arterial occlusions in the same noncoronary, non‑intracranial vascular family using a combined mechanical thrombectomy and pharmacologic thrombolytic injection with fluoroscopic guidance. As an add‑on code, 37185 is reported when the provider treats a second or subsequent artery or arterial bypass graft after performing the initial same-method intervention on an index vessel. Nationally, this code matters because it captures incremental procedural work and resources when multiple vessels require similar endovascular revascularization during the same encounter.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent and service setting for 37185, along with the typical situations in which the add‑on code applies. The publication provides benchmarks and coding context for hospital and outpatient interventional settings, explains common use cases in peripheral arterial and graft thrombectomy, and summarizes policy and payment considerations that affect reporting of add‑on endovascular procedures. Content is national in scope and focuses on coding, clinical context, and payer coverage landscape. If specific payer policies, exact reimbursement rates, or local coverage determinations are needed, those details are addressed in payer-specific sections elsewhere.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 37185endovascular thrombectomymechanical thrombectomythrombolytic injectionfluoroscopic guidancevascular surgeryinterventional radiologyadd-on procedureperipheral arterial occlusion

Billing Code Overview

CPT code 37185 is an add-on endovascular thrombectomy procedure describing treatment of an occlusion in the second and all subsequent arteries or arterial bypass grafts of the same noncoronary, non-intracranial vascular family using a combined technique of mechanical thrombectomy with pharmacologic thrombolytic injection, performed with fluoroscopic guidance after an initial vessel in the same vascular family has been treated by the same method.

Service type: Endovascular thrombectomy with combined mechanical and pharmacologic thrombolysis (add-on)

Typical site of service: Hospital-based interventional radiology or vascular surgery suite (angiography/fluoroscopy-capable procedural setting)

Data not available in the input for: associated taxonomies, specific ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old with peripheral arterial occlusive disease who presents with acute limb ischemia of the lower extremity characterized by sudden onset of worsening pain, pallor, pulselessness, paresthesia, and paralysis. After initial assessment with duplex ultrasound and/or CT angiography confirming thrombotic occlusion in multiple tibial or femoropopliteal arteries or in an arterial bypass graft, the vascular interventional team proceeds to catheter-based intervention in an angiography suite or hybrid operating room. The provider performs mechanical thrombectomy with fluoroscopic guidance to remove thrombus from an initial affected artery or graft and administers intra-arterial pharmacologic thrombolytic injection. When a second (or subsequent) artery or bypass graft within the same noncoronary, non‑intracranial vascular family requires the same combined mechanical plus pharmacologic approach during the same session, CPT 37185 is reported as the add-on code. Typical workflow steps: pre-procedure informed consent and coagulation/anticoagulation review; vascular access (commonly common femoral artery); baseline angiography; mechanical thrombectomy under fluoroscopic guidance of the first vessel with local thrombolytic infusion as indicated; reassessment angiography; repeat mechanical thrombectomy and thrombolytic injection in the second (and subsequent) vessel(s) using the same technique; completion angiogram; hemostasis and post-procedure monitoring in an inpatient or observation setting if necessary. Typical site of service: hospital inpatient, hospital outpatient (ambulatory surgical center if equipped), or hybrid angiography suite. Service type: endovascular interventional radiology / vascular surgery procedure with image guidance and thrombolytic administration.

Coding Specifications

Modifier	Description	When to Use

CPT 37184: Endovascular Thrombectomy with Catheter-Directed Thrombolysis

CPT-37186-ENDOVASCULAR-THROMBECTOMY-NONCORONARY-ARTERY

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

Taxonomy Code	Specialty	Notes
207P00000X	Vascular Surgery	Common treating specialty for peripheral arterial mechanical thrombectomy and thrombolysis.
207H00000X	Interventional Cardiology	May perform peripheral endovascular procedures in some systems, though focus is coronary and structural.
2085P0200X	Interventional Radiology	Frequent operator for image-guided mechanical thrombectomy and local thrombolytic delivery.
2080S0004X	General Surgery (Vascular-trained)	General surgeons with vascular training who perform endovascular thrombus removal and graft interventions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Common indication for mechanical thrombectomy and thrombolytic therapy in acute limb ischemia.
`I74.4`	Embolism and thrombosis of arteries of lower extremity, unspecified	Used when laterality or specific arterial segment details are not specified; relevant to thrombectomy procedures.
`I74.5`	Embolism and thrombosis of mesenteric artery	Mesenteric arterial thromboembolism may be treated with endovascular thrombectomy and local thrombolysis in select centers.
`I74.8`	Embolism and thrombosis of other arteries	Covers less common arterial beds (e.g., renal) where combined mechanical and pharmacologic thrombolysis may be applied.
`I80.2`	Phlebitis and thrombophlebitis of other deep vessels of lower extremities	While primarily venous, distinction from arterial thrombosis is important; some endovascular teams manage mixed pathology.
`I97.1`	Postprocedural arterial embolism and thrombosis of deep arteries	Relevant for thrombotic occlusions occurring after vascular procedures that may require repeat thrombectomy.
`Z95.2`	Presence of prosthetic vascular graft	Presence of bypass graft influences planning and may be the site of graft thrombosis requiring thrombectomy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37184`	Transcatheter mechanical thrombectomy, noncoronary, nonintracranial, initial vessel (includes fluoroscopic guidance) with pharmacologic thrombolytic injection	Reported for the first treated vessel; `37185` is reported as an add-on for the second and subsequent vessels when the same combined technique is used.
`36215`	Selective catheter placement, arterial system; each first order thoracic, abdominal, or pelvic branch vessel, with angiography	Often performed before thrombectomy to selectively catheterize target arteries for angiography and device delivery.
`75710`	Angiography, extremity, unilateral, radiological supervision and interpretation	Used for diagnostic angiography of the affected limb to identify level and extent of occlusion prior to or after thrombectomy.
`37220`	Revascularization, endovascular, open or percutaneous, by catheter; iliac artery, with transluminal stent placement(s), includes angioplasty when performed	May be performed after thrombus removal if residual stenosis requires angioplasty and stent placement.
`36016`	Introduction of needle and/or catheter into artery for diagnostic or therapeutic purposes, percutaneous, femoral approach; each catheter	Represents vascular access codes commonly reported when arterial access is obtained for procedure.

`59`	Distinct procedural service	Use when procedures are distinct or separate from other services on the same day and not normally billed together.
`76`	Repeat procedure by same physician	Use when the same procedure is repeated by the same provider during the same day.
`77`	Repeat procedure by another physician	Use when a different physician repeats the procedure the same day.
`62`	Two surgeon technique	Use when two surgeons work together as primary surgeons during the procedure.
`26`	Professional component	Use when billing only the physician professional interpretation or service separate from technical component.
`52`	Reduced services	Use when the procedure is partially reduced or not completed.
`53`	Discontinued procedure	Use when procedure is started but terminated for reasons related to the patient’s welfare.
`59`	Distinct procedural service	Use when services that are normally bundled are separate and independent.
`22`	Increased procedural services	Use when work required is substantially greater than typically required for the service.
`50`	Bilateral procedure	Use when the same procedure is performed bilaterally and payer requires bilateral modifier.
`RT`	Right side	Use to identify procedures performed on the right side when laterality is relevant.
`LT`	Left side	Use to identify procedures performed on the left side when laterality is relevant.
`XU`	Unusual non-overlapping service	Use to indicate a service that is distinct because it does not overlap usual components.
`XE`	Separate encounter	Use when service was performed during a separate encounter on a different date.

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