CPT 37255 Iliac Angioplasty Reimbursement

CPT code 37255 covers angioplasty of a straightforward lesion in an additional iliac vessel performed during the same session as an initial iliac revascularization. The code captures the incremental work of treating an extra lesion within the iliac vascular territory (common, internal, or external iliac arteries) and includes all access, catheterization, lesion crossing, and imaging guidance required to complete the procedure. Nationally, this code matters because iliac endovascular interventions are common components of peripheral arterial disease management and affect hospital and ambulatory surgery center resource use and payment bundling.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and coding description, typical sites of service, common billing considerations, and the context needed to interpret coverage and reimbursement discussions across major commercial and public payers. The content highlights the procedural context—added angioplasty within the same session as initial iliac revascularization—so stakeholders can understand when 37255 applies, how it interacts with primary iliac revascularization services, and where to look for policy nuances. Data not available in the input is noted where applicable.

Billing Code Overview

CPT code 37255 describes angioplasty (balloon expansion) of a straightforward stenosis in an additional iliac artery performed in the same session as an initial iliac revascularization. The iliac vascular territory includes the common iliac, internal iliac, and external iliac arteries. The service encompasses all access, catheterization, lesion crossing, and imaging guidance necessary to complete the procedure. The approach may be open or percutaneous.

Service type: Add-on peripheral vascular angioplasty performed during the same session as initial iliac revascularization

Typical site of service: Hospital inpatient or outpatient interventional suite / ambulatory surgery center, depending on clinical setting and approach.

Clinical Context

A 68-year-old male with progressive right lower-extremity claudication and an ankle-brachial index of 0.6 is diagnosed with symptomatic peripheral arterial disease involving the iliac segment. Pre-procedure CTA shows a primary lesion in the right common iliac artery successfully treated with an initial iliac revascularization (stent or angioplasty). During the same endovascular session the interventionalist identifies a separate, straightforward focal stenosis in the ipsilateral external iliac artery and performs balloon angioplasty of that additional vessel.

The clinical workflow includes: pre-procedure evaluation (history, vascular exam, noninvasive arterial testing, imaging review), informed consent, percutaneous arterial access (commonly common femoral), diagnostic angiography, treatment of the index iliac lesion (angioplasty ± stent), identification of the second straightforward lesion within the same iliac vascular territory, performance of balloon angioplasty of that additional lesion (including catheterization, lesion crossing, inflation/deflation with appropriate balloon sizing), intraprocedural imaging guidance (fluoroscopy/angiography), hemostasis and access site management, and post-procedure monitoring with discharge planning and antiplatelet therapy as indicated.

Coding Specifications

Modifier	Description	When to Use
`-26`	Professional component	When reporting only the physician’s professional interpretation component separate from technical facility charges (rare for endovascular procedures)

Taxonomy Code	Specialty	Notes
`2085R0200X`	Interventional Cardiology	Performs peripheral endovascular interventions including iliac angioplasty and stenting
`207R00000X`	Vascular Surgery	Surgical specialists commonly performing iliac revascularization and adjunct angioplasty
`207T00000X`	Thoracic and Cardiovascular Surgery	May perform open and endovascular iliac procedures
`225100000X`	Interventional Radiology	Image-guided endovascular treatment of iliac arterial disease
`2084P0222X`	Peripheral Vascular Medicine	Clinicians specializing in peripheral vascular disease management and interventions

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs	Common underlying etiology for iliac stenosis leading to angioplasty
`I70.233`	Atherosclerosis of native arteries of extremities with intermittent claudication, left leg	Unilateral symptomatic peripheral arterial disease prompting iliac intervention
`I70.243`	Atherosclerosis of native arteries of extremities with intermittent claudication, right leg	Side-specific code used when right-sided iliac disease is treated
`I70.209`	Atherosclerosis of native arteries of extremities without claudication, unspecified extremity	May be used when ischemia is present but classic claudication is not documented
`I73.9`	Peripheral vascular disease, unspecified	General PVD code sometimes used as a secondary diagnosis in iliac interventions

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37254`	Transcatheter placement of an intravascular stent(s), open or percutaneous; iliac artery	Often performed for the primary iliac lesion before or instead of angioplasty; may be performed in the same session
`37236`	Transcatheter therapy, balloon angioplasty, other peripheral arterial disease, percutaneous, initial vessel	Used for peripheral angioplasty of non-iliac vessels; represents initial angioplasty codes for other territories during the same encounter
`36247`	Selective catheter placement, arterial system; each first order thoracic or abdominal branch, when performed	May be reported for selective catheterization required to access iliac vessels depending on payer rules
`36248`	Selective catheter placement, arterial system; each additional second order thoracic or abdominal branch	Additional selective catheter placement codes when multiple vessel catheterizations are performed
`75960`	Angiography, extremity, unilateral, radiological supervision and interpretation, initial lesion assessment	Diagnostic angiography and imaging guidance performed during iliac endovascular interventions
`37255`	Angioplasty of an additional vessel of the iliac vascular bed at the same session as initial iliac revascularization	Describes the balloon angioplasty of the additional straightforward iliac lesion performed during the same session

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Summary & Overview

CPT 37255: Iliac Angioplasty for Additional Straightforward Lesion