CPT 37241 Venous Occlusion Reimbursement | OpenPayer

Summary & Overview

CPT 37241: Venous Occlusion/Embolization for Non-Hemorrhagic Conditions

CPT code 37241 represents a physician-performed procedure to partially or completely block venous blood flow for non-hemorrhagic conditions such as venous malformations, hemangiomas, varicoceles, and varices. Nationally, this endovascular or percutaneous venous occlusion/embolization procedure is clinically significant because it addresses symptomatic venous lesions that can cause pain, functional impairment, or progressive vascular complications. Payment policy and utilization for this code affect hospital outpatient, ambulatory surgery center, and interventional radiology practice settings.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides readers with benchmarking context on coverage and reimbursement posture, notes relevant policy updates and coding guidance where available, and situates the clinical indications and typical care settings for the procedure. Readers will gain an understanding of the clinical context for CPT code 37241, the common sites of service, and the payer landscape that shapes access and billing for venous occlusion procedures. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare37241CPTvenous-embolizationinterventional-radiologyvascular-proceduresambulatory-surgeryhospital-outpatient

Billing Code Overview

CPT code 37241 describes a physician-performed procedure to partially or completely block venous blood flow in a target area for non-hemorrhagic indications. The service is commonly used to treat venous malformations, hemangiomas, varicoceles, and varices by occluding abnormal or symptomatic veins.

Service Type: Endovascular or percutaneous venous occlusion/embolization procedure

Typical Site of Service: Hospital inpatient, hospital outpatient/ambulatory surgery center, or interventional radiology suite

Clinical & Coding Specifications

Clinical Context

A 28-year-old patient presents to an outpatient interventional radiology clinic with a painful, enlarging venous malformation of the right lower extremity that has failed conservative therapy (compression and analgesia). Imaging with duplex ultrasound and MRI confirms a low-flow venous malformation localized to the calf veins without acute hemorrhage. The interventional radiologist schedules a session for percutaneous sclerotherapy and venous embolization to partially or completely occlude abnormal venous channels. The procedure is performed under moderate sedation in an ambulatory surgery center. Ultrasound and fluoroscopic guidance are used to access the lesion, deliver sclerosant and embolic agents, and confirm cessation of flow. Postprocedural monitoring occurs in recovery for several hours; discharge instructions include wound care, activity restrictions, and follow-up in clinic.

Patient workflow: referral from vascular medicine or pediatrics, preprocedural consent and labs, imaging review, procedure scheduling at an outpatient surgical or hospital-based interventional suite, intraprocedural image-guided venous occlusion, postprocedure observation, and follow-up angiographic or ultrasound assessment if symptoms persist or recurrence is suspected.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal, usual, or customary service	Use when service performed is the provider's usual service; often default when no other modifier applies.

CPT 37242: Endovascular Arterial Occlusion/Embolization Procedure

CPT-37244-VASCULAR-OCCLUSION-HEMORRHAGE-CONTROL

CPT 37244: Vascular Occlusion for Hemorrhage or Extravasation

37248-TRANSLUMINAL-BALLOON-ANGIOPLASTY-EXCEPT-DIALYSIS-CIRCUIT

CPT 37248: Transluminal Balloon Angioplasty of Vein, Open or Percutaneous

CPT-37243-ENDOVASCULAR-EMBOLIZATION-VASCULAR-OCCLUSION-TUMOR-FIBROID

CPT 37243: Endovascular Embolization for Tumors or Ischemia

Taxonomy Code	Specialty	Notes
208D00000X	Vascular Surgery	Frequently performs venous embolization and sclerotherapy for varices and venous malformations.
2084P0800X	Interventional Radiology	Most commonly performs image-guided venous occlusion procedures like `37241`.
207RG0100X	General Surgery	May perform venous procedures in hospital settings, especially for varices.
208000000X	Diagnostic Radiology	Provides imaging guidance and often performs interventional venous procedures when credentialed.
363L00000X	Hematology/Oncology	Rarely involved for complex venous malformations with bleeding risk or coagulopathy; consultative role.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I83.90`	Varicose veins of unspecified lower extremity without ulcer or inflammation	Common indication for venous occlusion when symptomatic varices fail conservative therapy.
`I86.1`	Varix of lower extremity	Directly related to procedures that occlude abnormal venous channels.
`Q27.3`	Congenital malformation of veins	Venous malformations and hemangiomas requiring targeted venous occlusion.
`D18.0`	Hemangioma of skin and subcutaneous tissue	Hemangiomas that may be treated with venous embolization or sclerotherapy.
`I83.10`	Varicose veins of right lower extremity with pain	Symptomatic varices with pain are an indication for interventional occlusion.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37242`	Endovascular occlusion or embolization, inclusive of all radiological supervision and interpretation; more extensive venous territory	Performed when occlusion involves multiple venous segments or requires more extensive embolization than `37241`.
`37244`	Revascularization, open or percutaneous, of venous or arterial systems (selective), including angioplasty and stent when combined	May be performed if concurrent venous stenting or angioplasty is required in the same treatment plan.
`36010`	Introduction of needle or catheter into a peripheral vein	May be performed for venous access or diagnostic venography preceding `37241`.
`76937`	Ultrasound guidance for vascular access	Used for ultrasound-guided percutaneous access of the venous malformation prior to embolization.
`77012`	CT guidance for needle placement	Used when CT guidance is required for access to complex venous malformations not amenable to ultrasound or fluoroscopy.

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