CPT 37186 Endovascular Thrombectomy Reimbursement | OpenPayer

Summary & Overview

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

CPT code 37186 covers endovascular removal of thrombus or embolus from noncoronary, non–intracranial arterial occlusions or from arterial bypass grafts performed before or after a percutaneous intervention, under fluoroscopic guidance. This code captures a technically specialized adjunct procedure commonly performed during peripheral arterial interventions to restore patency and improve perfusion. Nationally, accurate coding for 37186 affects procedural reporting, utilization monitoring, and payment for hospitals and interventional practices treating peripheral arterial thromboembolic disease.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find context on clinical indications and typical sites of service, commonly reported modifiers, and how 37186 interacts with related peripheral endovascular procedure coding. The publication summarizes benchmark considerations for service lines that frequently bill this code, highlights common billing pitfalls, and outlines areas where documentation must support the use of an adjunct thrombectomy or embolectomy during percutaneous arterial treatment.

The content is intended for coding professionals, interventionalists, revenue cycle staff, and policy analysts seeking a concise reference on national coding practice and operational implications for CPT code 37186.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare37186CPTendovascular thrombectomyperipheral arterial interventioninterventional radiologycatheterization labvascular surgeryprocedure coding

Billing Code Overview

CPT code 37186 describes endovascular removal of thrombus or embolus from a noncoronary, non–intracranial arterial occlusion or from an arterial bypass graft performed either before or after a percutaneous intervention such as stent placement or balloon angioplasty. The procedure is performed under fluoroscopic guidance and may use mechanical thrombectomy devices, aspiration, or other intravascular methods to extract small sections of thrombus or embolic material.

Service type: Endovascular thrombectomy/embolus extraction performed in conjunction with percutaneous arterial interventions
Typical site of service: Hospital or ambulatory surgical center catheterization laboratory or interventional radiology suite

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with acute limb ischemia presents to the hospital with sudden onset left lower extremity pain, pallor, and diminished distal pulses. Imaging (duplex ultrasound and CT angiography) demonstrates an occlusive thrombus within the left femoral-popliteal arterial segment. The vascular surgery/interventional radiology team schedules an endovascular procedure. Under conscious sedation in an angiography suite, the physician obtains arterial access and performs diagnostic angiography under fluoroscopy. Percutaneous mechanical thrombectomy (37186) is performed to remove small sections of the thrombus from the affected noncoronary arterial segment, either before or after adjunctive balloon angioplasty or stent placement to restore luminal patency. Intra-procedural radiographic guidance is used throughout, with hemodynamic monitoring and post-procedure angiographic runs to confirm flow restoration. Typical sites of service include the hospital-based angiography suite, endovascular operating room, or an interventional radiology suite. Common clinical workflow components include pre-procedure consent and imaging review, vascular access and diagnostic angiography, thrombectomy (37186), possible adjunctive percutaneous transluminal angioplasty or stent placement, hemostasis, post-procedure monitoring, and discharge planning with anticoagulation and follow-up vascular care.

Coding Specifications

Modifier	Description	When to Use
`26`

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

CPT-37184-ENDOVASCULAR-THROMBECTOMY-CATHETER-THROMBOLYSIS

CPT 37184: Endovascular Thrombectomy with Catheter-Directed Thrombolysis

Taxonomy Code	Specialty	Notes
207P00000X	Vascular Surgery	Primary specialty performing peripheral arterial thrombectomy and adjunctive interventions.
208800000X	Interventional Radiology	Commonly performs percutaneous endovascular thrombectomy under fluoroscopic guidance.
2084P0800X	Cardiovascular Disease (Interventional Cardiology)	May perform noncoronary peripheral interventions in some centers.
207K00000X	General Surgery	Vascular-trained general surgeons may perform peripheral thrombectomy procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Direct indication for peripheral arterial thrombectomy to remove arterial thrombus/embolus.
`I80.2`	Phlebitis and thrombophlebitis of other deep vessels of lower extremities	Related venous thrombotic disease; may be comorbid but not a direct indication for arterial thrombectomy.
`I70.231`	Atherosclerosis of native arteries of right leg with rest pain	Underlying peripheral arterial disease often coexists and may require adjunctive angioplasty or stenting.
`I70.332`	Atherosclerosis of native arteries of left leg with ulceration of calf	Chronic limb ischemia setting where thrombectomy may be needed for acute-on-chronic occlusion.
`I96`	Gangrene, not elsewhere classified	Severe ischemia with tissue loss where revascularization including thrombectomy may be indicated to salvage limb.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37220`	Transcatheter placement of intravascular stent(s), non-coronary, percutaneous, includes angioplasty when performed; initial vessel	Often performed after thrombectomy to treat underlying atherosclerotic stenosis that contributed to occlusion.
`37224`	Revascularization, endovascular, open or percutaneous, infrainguinal, including angioplasty and stent when performed; initial vessel	Used for infrainguinal angioplasty/stent procedures that may accompany or follow `37186`.
`36475`	Endovenous ablation therapy of incompetent vein, radiofrequency; 1 vein	May be performed in different contexts; not typical for acute arterial thrombectomy but listed as commonly used in vascular suites.
`75710`	Angiography, extremity, unilateral, radiological supervision and interpretation	Diagnostic angiography runs performed before, during, or after `37186` to define anatomy and confirm results.
`93975`	Duplex scan of extremity arteries, complete bilateral study	Pre- or post-procedure noninvasive arterial duplex used to evaluate occlusion and procedural success.

OpenPayer