Summary & Overview
CPT 37242: Endovascular Arterial Occlusion/Embolization Procedure
CPT code 37242 designates a therapeutic endovascular arterial occlusion or embolization procedure performed to partially or completely block arterial blood flow in a target area for non-hemorrhagic, non-oncologic indications. The code is commonly used for treatment of arteriovenous malformations, arteriovenous fistulas, aneurysms, and pseudoaneurysms. Nationally, this code matters because it captures complex interventional radiology and endovascular therapy that can avert rupture, reduce shunting, or stabilize vascular lesions, with implications for facility and professional payment, utilization monitoring, and quality measurement.
Key payers covered in this analysis include 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 where it is billed, common billing modifiers provided in the input, and expected areas of insurer policy focus such as medical necessity criteria and documentation of target lesions. The publication will summarize available benchmarks where present, note Data not available in the input where payer-specific details or associated taxonomies/diagnoses are missing, and outline the billing and service-line context necessary for revenue cycle and compliance teams to codify encounters accurately.
This national summary is intended for clinicians, billing professionals, and policy analysts seeking a concise reference on CPT code 37242 and its clinical and administrative relevance.
Billing Code Overview
CPT code 37242 describes an endovascular procedure in which the physician partially or completely blocks arterial blood flow in a targeted vascular territory for indications unrelated to hemorrhage or tumor treatment. Typical clinical uses include management of arteriovenous malformations or fistulas, aneurysms, or pseudoaneurysms.
Service type: Therapeutic endovascular arterial occlusion/embolization.
Typical site of service: Hospital inpatient or hospital outpatient interventional radiology suites, and ambulatory surgical centers equipped for endovascular procedures.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient with a known intracranial arteriovenous malformation (AVM) is referred to neurointerventional radiology after progressive headaches and focal neurologic deficits. Diagnostic cerebral angiography confirmed a nidus with arterial feeders suitable for endovascular embolization. The patient is admitted to an endovascular suite or hybrid operating room for a planned arterial occlusion procedure. Under general anesthesia, vascular access is obtained (commonly femoral or radial), microcatheter navigation to the target arterial feeders is performed, and embolic agents (e.g., coils, liquid embolic agents) are delivered to partially or completely block arterial flow to the lesion. The procedure is billed when arterial blood flow is intentionally reduced or occluded for non-hemorrhagic, non-oncologic indications such as AVMs, AV fistulas, aneurysms, or pseudoaneurysms. Post-procedure, the patient is monitored in a post-anesthesia care unit or neuro-ICU with follow-up imaging to confirm occlusion and assess for complications such as ischemia or vessel injury.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal/integral procedure | Use when the service is the primary, standard procedure performed. |
22 |