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CPT 37253: Intravascular Ultrasound for Additional Noncoronary Vessel

CPT code 37253 is an add-on code for intravascular ultrasound (IVUS) performed in each additional noncoronary vessel during diagnostic or interventional vascular procedures. IVUS provides high-resolution, intraluminal imaging via a catheter-mounted ultrasound transducer to assess vessel morphology, guide stent placement, and confirm treatment success. As an add-on code, 37253 is reported in conjunction with the primary procedure for the first vessel and captures additional vessel imaging when clinically indicated. Nationally, IVUS supports precision in endovascular care and can affect procedure planning, device selection, and documentation requirements.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find the clinical context for when intravascular ultrasound is used in noncoronary vessels, how 37253 functions as an add-on reporting mechanism, and what operational areas typically apply (hospital catheterization labs, endovascular suites, and interventional radiology). The publication summarizes benchmark considerations, payer coverage themes, and relevant documentation elements needed to support reporting of add-on noncoronary IVUS. Data not available in the input are noted where applicable.

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Billing Code Overview

CPT code 37253 describes an add-on intravascular ultrasound (IVUS) procedure for each additional noncoronary vessel evaluated during a diagnostic or interventional therapeutic vascular procedure. The procedure uses a catheter with an ultrasound transducer that is inserted into the vessel (intravascular) to image the vessel interior and guide or assess interventions such as stent placement for obstructions or blockages.

Service type: Intravascular ultrasound imaging as an add-on service during diagnostic or interventional vascular procedures (noncoronary)
Typical site of service: Hospital catheterization lab, endovascular suite, or interventional radiology suite

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

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CPT 37253: Intravascular Ultrasound for Additional Noncoronary Vessel

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Billing Code Overview

Service type: Intravascular ultrasound imaging as an add-on service during diagnostic or interventional vascular procedures (noncoronary)
Typical site of service: Hospital catheterization lab, endovascular suite, or interventional radiology suite

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

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with peripheral arterial disease presents with progressive claudication and an angiographically significant stenosis of the superficial femoral artery during a planned endovascular intervention. The interventionalist performs diagnostic angiography followed by lesion crossing and balloon angioplasty with possible stent placement. During this noncoronary endovascular procedure the provider inserts an intravascular ultrasound catheter to visualize vessel lumen size, plaque morphology, and stent apposition to guide appropriate device sizing and optimal treatment. The procedure typically occurs in an inpatient or outpatient hospital-based cardiac catheterization lab or vascular interventional suite; radiology supervision and interpretation are performed by the attending interventionalist or vascular specialist. Clinical workflow: pre-procedure consent and evaluation, vascular access (commonly femoral), baseline angiography, intravascular ultrasound (IVUS) catheter insertion and imaging of the target vessel(s), therapeutic intervention (angioplasty/stent) as indicated, repeat IVUS to confirm results, hemostasis, and post-procedure monitoring and documentation including radiological interpretation.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician interpretation portion when technical component is billed by facility.
`59`	Distinct procedural service	Use when `IVUS` is distinct from other procedures provided at the same session and documentation supports separate and distinct services.
`76`	Repeat procedure by same physician	Use if a repeat `IVUS` of the same vessel is medically necessary and performed by the same provider during the same encounter.
`77`	Repeat procedure by another physician	Use if another physician repeats the `IVUS` of the same vessel during the encounter.
`52`	Reduced services	Use when the `IVUS` study was partially reduced or not completed as documented.
`53`	Discontinued procedure	Use when `IVUS` was started but discontinued due to extenuating circumstances.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure	Use for complications requiring immediate return to the suite where additional `IVUS` guidance is performed.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when `IVUS` is unrelated to the original procedure during global period.
`62`	Two surgeons	Use when two surgeons of different specialties share responsibility during a complex vascular intervention where `IVUS` is used.
`76`	Repeat procedure by same physician	Use when the same physician repeats `IVUS` in a different vessel during the same session (note: `37253` is an add-on for each additional noncoronary vessel).
`RT`	Right side	Use to identify procedures performed on the right-sided extremity vessel when laterality reporting is required.
`LT`	Left side	Use to identify procedures performed on the left-sided extremity vessel when laterality reporting is required.
`TC`	Technical component	Use when facility bills the technical portion of `IVUS` imaging separate from professional interpretation.
`QX`	CRNA service: medically directed by anesthesiologist	Use when anesthesia services meet `QX` criteria during the procedure.

Taxonomy Code	Specialty	Notes
207K00000X	Interventional Cardiology	Interventionalists experienced with endovascular imaging and peripheral interventions.
207RG0200X	Interventional Radiology	Commonly performs peripheral arterial interventions and `IVUS` imaging.
207L00000X	Vascular Surgery	Vascular surgeons performing endovascular treatments of peripheral arteries.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.219`	Atherosclerosis of native arteries of the extremities, bilateral legs, unspecified	Peripheral arterial disease causing limb ischemia and claudication prompting endovascular evaluation and `IVUS`.
`I70.213`	Atherosclerosis of native arteries of the extremities with ulceration, right leg	Complicated peripheral atherosclerosis where `IVUS` assists in lesion assessment and treatment planning.
`I70.214`	Atherosclerosis of native arteries of the extremities with ulceration, left leg	Same clinical relevance for left-sided peripheral arterial disease requiring endovascular therapy with `IVUS`.
`I70.201`	Atherosclerosis of native arteries of the extremities, right leg, unspecified	Common indication for diagnostic angiography and `IVUS` during intervention.
`I70.202`	Atherosclerosis of native arteries of the extremities, left leg, unspecified	As above for left-sided disease guiding endovascular treatment with `IVUS`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37220`	Revascularization, endovascular, open or percutaneous, femoral-popliteal artery, unilateral; initial segment including angioplasty	Often performed before or with `IVUS` to treat a femoropopliteal lesion; angioplasty may be guided by `IVUS`.
`37224`	Revascularization, endovascular, tibial/peroneal, including angioplasty when performed; single vessel	Used for below-knee interventions where `IVUS` may be used for vessel assessment.
`37221`	Revascularization, endovascular, femoral-popliteal artery; each additional vessel (list separately in addition to code for primary vessel)	Performed in multivessel peripheral interventions; `IVUS` add-on `37253` may be reported for each additional noncoronary vessel imaged.
`37254`	Transcatheter placement of intravascular stent(s), non-coronary, each additional vessel	Stent placement often follows angioplasty; `IVUS` guides sizing and apposition assessment.
`75989`	Angiography, peripheral, unilateral, radiological supervision and interpretation	Diagnostic peripheral angiography commonly precedes or accompanies `IVUS` imaging and provides complementary lumen imaging.

CPT 37252: Intravascular Ultrasound for Noncoronary Vessel

CPT-37255-ILIAC-ANGIOPLASTY-ADD-ON-LESION

CPT 37255: Iliac Angioplasty for Additional Straightforward Lesion

CPT-37257-ILIAC-ANGIOPLASTY-COMPLEX-LESION-ADDITIONAL-VESSEL

CPT 37257: Iliac Angioplasty for Complex Lesion in Additional Vessel

CPT-37258-ILIAC-ARTERY-STENT-PLACEMENT-INITIAL-VESSEL-STRAIGHTFORWARD-LESION

CPT 37258: Iliac Artery Stent Placement for Straightforward Lesion

CPT-37260-ILIAC-ARTERY-STENT-PLACEMENT-COMPLETE-OCCLUSION

CPT 37260: Iliac Artery Stent Placement for Occlusive Lesion

CPT-37261-ILIAC-STENT-PLACEMENT-ADDITIONAL-VESSEL

CPT 37261: Stent Placement in Additional Iliac Vessel During Initial Revascularization

CPT-37263-FEMORAL-POPLITEAL-ANGIOPLASTY-BALLOON

CPT 37263: Femoral and Popliteal Balloon Angioplasty

CPT-37264-FEMORAL-POPLITEAL-ADDITIONAL-VESSEL-ANGIOPLASTY

CPT 37264: Additional-Vessel Femoral/Popliteal Angioplasty

CPT-37265-FEMORAL-POPLITEAL-COMPLEX-LESION-ANGIOPLASTY

CPT 37265: Angioplasty of Complex Femoral-Popliteal Occlusive Lesion

CPT-37267-FEMORAL-POPLITEAL-STENT-PLACEMENT

CPT 37267: Femoral and Popliteal Arterial Stent Placement

Showing 1–10 of 32

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician interpretation portion when technical component is billed by facility.
`59`	Distinct procedural service	Use when `IVUS` is distinct from other procedures provided at the same session and documentation supports separate and distinct services.
`76`	Repeat procedure by same physician	Use if a repeat `IVUS` of the same vessel is medically necessary and performed by the same provider during the same encounter.
`77`	Repeat procedure by another physician	Use if another physician repeats the `IVUS` of the same vessel during the encounter.
`52`	Reduced services	Use when the `IVUS` study was partially reduced or not completed as documented.
`53`	Discontinued procedure	Use when `IVUS` was started but discontinued due to extenuating circumstances.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure	Use for complications requiring immediate return to the suite where additional `IVUS` guidance is performed.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when `IVUS` is unrelated to the original procedure during global period.
`62`	Two surgeons	Use when two surgeons of different specialties share responsibility during a complex vascular intervention where `IVUS` is used.
`76`	Repeat procedure by same physician	Use when the same physician repeats `IVUS` in a different vessel during the same session (note: `37253` is an add-on for each additional noncoronary vessel).
`RT`	Right side	Use to identify procedures performed on the right-sided extremity vessel when laterality reporting is required.
`LT`	Left side	Use to identify procedures performed on the left-sided extremity vessel when laterality reporting is required.
`TC`	Technical component	Use when facility bills the technical portion of `IVUS` imaging separate from professional interpretation.
`QX`	CRNA service: medically directed by anesthesiologist	Use when anesthesia services meet `QX` criteria during the procedure.

Taxonomy Code	Specialty	Notes
207K00000X	Interventional Cardiology	Interventionalists experienced with endovascular imaging and peripheral interventions.
207RG0200X	Interventional Radiology	Commonly performs peripheral arterial interventions and `IVUS` imaging.
207L00000X	Vascular Surgery	Vascular surgeons performing endovascular treatments of peripheral arteries.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.219`	Atherosclerosis of native arteries of the extremities, bilateral legs, unspecified	Peripheral arterial disease causing limb ischemia and claudication prompting endovascular evaluation and `IVUS`.
`I70.213`	Atherosclerosis of native arteries of the extremities with ulceration, right leg	Complicated peripheral atherosclerosis where `IVUS` assists in lesion assessment and treatment planning.
`I70.214`	Atherosclerosis of native arteries of the extremities with ulceration, left leg	Same clinical relevance for left-sided peripheral arterial disease requiring endovascular therapy with `IVUS`.
`I70.201`	Atherosclerosis of native arteries of the extremities, right leg, unspecified	Common indication for diagnostic angiography and `IVUS` during intervention.
`I70.202`	Atherosclerosis of native arteries of the extremities, left leg, unspecified	As above for left-sided disease guiding endovascular treatment with `IVUS`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37220`	Revascularization, endovascular, open or percutaneous, femoral-popliteal artery, unilateral; initial segment including angioplasty	Often performed before or with `IVUS` to treat a femoropopliteal lesion; angioplasty may be guided by `IVUS`.
`37224`	Revascularization, endovascular, tibial/peroneal, including angioplasty when performed; single vessel	Used for below-knee interventions where `IVUS` may be used for vessel assessment.
`37221`	Revascularization, endovascular, femoral-popliteal artery; each additional vessel (list separately in addition to code for primary vessel)	Performed in multivessel peripheral interventions; `IVUS` add-on `37253` may be reported for each additional noncoronary vessel imaged.
`37254`	Transcatheter placement of intravascular stent(s), non-coronary, each additional vessel	Stent placement often follows angioplasty; `IVUS` guides sizing and apposition assessment.
`75989`	Angiography, peripheral, unilateral, radiological supervision and interpretation	Diagnostic peripheral angiography commonly precedes or accompanies `IVUS` imaging and provides complementary lumen imaging.

CPT 37252: Intravascular Ultrasound for Noncoronary Vessel

CPT-37255-ILIAC-ANGIOPLASTY-ADD-ON-LESION

CPT 37255: Iliac Angioplasty for Additional Straightforward Lesion

CPT-37257-ILIAC-ANGIOPLASTY-COMPLEX-LESION-ADDITIONAL-VESSEL

CPT 37257: Iliac Angioplasty for Complex Lesion in Additional Vessel

CPT-37258-ILIAC-ARTERY-STENT-PLACEMENT-INITIAL-VESSEL-STRAIGHTFORWARD-LESION

CPT 37258: Iliac Artery Stent Placement for Straightforward Lesion

CPT-37260-ILIAC-ARTERY-STENT-PLACEMENT-COMPLETE-OCCLUSION

CPT 37260: Iliac Artery Stent Placement for Occlusive Lesion

CPT-37261-ILIAC-STENT-PLACEMENT-ADDITIONAL-VESSEL

CPT 37261: Stent Placement in Additional Iliac Vessel During Initial Revascularization

CPT-37263-FEMORAL-POPLITEAL-ANGIOPLASTY-BALLOON

CPT 37263: Femoral and Popliteal Balloon Angioplasty

CPT-37264-FEMORAL-POPLITEAL-ADDITIONAL-VESSEL-ANGIOPLASTY

CPT 37264: Additional-Vessel Femoral/Popliteal Angioplasty

CPT-37265-FEMORAL-POPLITEAL-COMPLEX-LESION-ANGIOPLASTY

CPT 37265: Angioplasty of Complex Femoral-Popliteal Occlusive Lesion

CPT-37267-FEMORAL-POPLITEAL-STENT-PLACEMENT

CPT 37267: Femoral and Popliteal Arterial Stent Placement

Showing 1–10 of 32

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 37253: Intravascular Ultrasound for Additional Noncoronary Vessel

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Billing Code Overview

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CPT 37253: Intravascular Ultrasound for Additional Noncoronary Vessel

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 37253: Intravascular Ultrasound for Additional Noncoronary Vessel

Sign up for cpt 37253 policy alerts

Billing Code Overview

CPT 37253: Intravascular Ultrasound for Additional Noncoronary Vessel

Sign up for cpt 37253 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 37253 describe and when is it reported?

Where and by which specialties is CPT 37253 typically performed?

Which modifiers are relevant when reporting CPT 37253 and what do they indicate?

What procedures and CPT codes are commonly associated with CPT 37253 during peripheral interventions?

What clinical situations and documentation elements support the use of CPT 37253?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 37253 describe and when is it reported?

Where and by which specialties is CPT 37253 typically performed?

Which modifiers are relevant when reporting CPT 37253 and what do they indicate?

What procedures and CPT codes are commonly associated with CPT 37253 during peripheral interventions?

What clinical situations and documentation elements support the use of CPT 37253?

References