Summary & Overview
CPT 37258: Iliac Artery Stent Placement for Straightforward Lesion
CPT code 37258 represents stent placement, with or without angioplasty, for a straightforward stenotic lesion in an initial iliac artery (common, internal, or external). It encompasses all components of the intervention, including access, catheterization, lesion crossing, and imaging guidance, and can be performed via open or percutaneous approaches. This code is important nationally because iliac artery interventions are a common element of peripheral arterial disease management and account for significant procedural volume and spending in vascular services.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, information on typical sites of service, and an overview of what a billing event under this code generally includes. The publication also provides benchmarking and reimbursement context, payer policy summaries where available, and related coding considerations to support billing and revenue cycle clarity.
This material is written for a national audience of clinicians, billing professionals, and policy analysts seeking a clear reference for CPT code 37258 — its clinical scope, where it is typically performed, and what topics to review for payer coverage and coding alignment.
Billing Code Overview
CPT code 37258 describes stent placement, with or without angioplasty, for a straightforward lesion in an initial iliac artery (common, internal, or external iliac). The procedure includes all access, catheterization, lesion crossing, and imaging guidance required to complete the intervention. The approach may be open or percutaneous.
Service type: Endovascular revascularization with stent deployment (iliac artery, initial vessel, straightforward lesion)
Typical site of service: Hospital inpatient or outpatient interventional suite, or ambulatory surgical center, depending on clinical status and facility capabilities.
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Clinical & Coding Specifications
Clinical Context
A 68-year-old male with progressive right-sided claudication and an ankle-brachial index of 0.65 presents after conservative therapy failure. Noninvasive arterial imaging (duplex ultrasound and CT angiography) demonstrates a focal, straightforward atherosclerotic stenosis of the right external iliac artery prompting endovascular intervention. The patient is evaluated in the vascular surgery/vascular interventional radiology clinic, consents for stent placement with possible angioplasty, and is scheduled for a percutaneous endovascular procedure. On the day of service the patient undergoes conscious sedation in an interventional suite or hybrid operating room. Vascular access is obtained (commonly common femoral artery), diagnostic angiography is performed to localize the lesion, lesion crossing with guidewire and catheter is completed, angioplasty is performed if needed, and a stent is deployed in the iliac artery. Imaging guidance (fluoroscopy/angiography) is used throughout. Hemostasis is achieved via manual compression, closure device, or open exposure depending on access. Typical post-procedure workflow includes vascular monitoring in PACU, discharged same day or overnight observation depending on comorbidities, antiplatelet management per vascular team, and follow-up vascular imaging at 1–6 months.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician interpretation/reading of vascular imaging if distinct from technical component. |
| Distinct procedural service | Use when an unrelated, separate endovascular procedure is performed during the same session that is not typically bundled with stent placement.