Summary & Overview
CPT 37191: Inferior Vena Cava Filter Placement
CPT code 37191 covers percutaneous placement of an inferior vena cava (IVC) filter via groin or neck venous access under imaging guidance. The procedure is performed to prevent venous thromboemboli from lower extremity deep vein thrombosis from reaching the pulmonary circulation, and it is a commonly billed endovascular intervention in interventional radiology and vascular surgery. Nationally, IVC filter placement is clinically significant for patients with acute venous thromboembolism who cannot receive anticoagulation or require temporary embolic protection.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for use of the code, typical sites of service, common modifiers associated with procedural billing, and the payer landscape. The publication summarizes reimbursement and billing considerations, identifies coding nuances relevant to documentation and imaging guidance, and highlights what to expect across major commercial insurers and Medicare. This summary is intended for revenue cycle professionals, billing coders, and clinical managers seeking a concise reference to the clinical and payer context of CPT code 37191.
Billing Code Overview
CPT code 37191 describes the percutaneous insertion of a filter into the inferior vena cava (IVC) via venous access at the groin or neck, with catheter manipulation and imaging guidance to deploy a device that prevents thromboemboli from lower-extremity deep vein thrombosis from reaching the heart and lungs. This procedure is an endovascular IVC filter placement intended to reduce risk of pulmonary embolism in patients with contraindications to anticoagulation or other clinical indications for filter use.
Service Type: Endovascular device placement / Interventional radiology procedure
Typical Site of Service: Hospital-based interventional radiology suite or catheterization laboratory; may also be performed in outpatient surgical centers equipped for vascular procedures
Clinical & Coding Specifications
Clinical Context
A typical patient is a 65-year-old hospitalized individual with a documented proximal lower-extremity deep vein thrombosis (DVT) and either contraindication to anticoagulation (active gastrointestinal bleeding, recent major surgery) or recurrent pulmonary embolism despite anticoagulation. The patient is referred to interventional radiology or vascular surgery for placement of an inferior vena cava (IVC) filter. Pre-procedure workflow includes informed consent, review of imaging (ultrasound of lower extremities, contrast CT or venography if available), assessment of coagulation status, and temporary withholding of anticoagulants as clinically indicated.
On the day of service the patient is brought to an angiography suite or hybrid operating room. Under sterile conditions and conscious sedation or monitored anesthesia care, the operator obtains venous access (common femoral vein at the groin or internal jugular vein at the neck), advances a guidewire and diagnostic catheter under fluoroscopic guidance to the infrarenal IVC, performs cavography to define anatomy and rule out thrombus at the deployment site, and deploys a retrievable or permanent IVC filter. Post-deployment venography confirms filter position and patency. The patient is observed in recovery; discharge planning includes documentation of indication, device type (retrievable vs permanent), retrieval plan if applicable, and instructions for follow-up imaging and anticoagulation management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |