Summary & Overview

CPT 37262: Intravascular Lithotripsy During Iliac Revascularization

CPT code 37262 identifies intravascular lithotripsy performed in one iliac artery at the same session as an initial iliac revascularization. The technique employs acoustic pressure waves to fracture arterial calcium, facilitating vessel dilation and device delivery during endovascular treatment. This code captures both the therapeutic lithotripsy and the necessary imaging and radiological supervision and interpretation.

This code matters nationally because calcified peripheral arterial disease is common in the iliac circulation and intravascular lithotripsy has emerged as an important adjunct to improve procedural success and potentially reduce complications. Major payers evaluated include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn the clinical context of the code, the typical sites of service where it is billed, and what to expect in a billing and coverage discussion. The publication provides benchmarks and policy-relevant context where available, summarizes payer coverage patterns, and outlines clinical indications and procedural scope tied to the code. Data not available in the input will be noted as such in the detailed sections of the publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare37262CPTiliac arteryintravascular lithotripsyendovascularperipheral arterial diseasevascular surgeryhospital outpatientambulatory surgery center

Billing Code Overview

CPT code 37262 describes intravascular lithotripsy of one iliac artery performed at the same session as an initial iliac revascularization service. The procedure uses focused sound waves to fracture calcified plaque within the iliac arterial territory, which includes the common iliac, internal iliac, and external iliac arteries. The service includes all imaging guidance and radiological supervision and interpretation required to complete the procedure.

Service type: Endovascular adjunctive therapy (intravascular lithotripsy during iliac revascularization)
Typical site of service: Hospital outpatient department or ambulatory surgery center, during the endovascular revascularization session

Clinical & Coding Specifications

Clinical Context

A 72-year-old man with progressive lifestyle-limiting right buttock and thigh claudication and an ankle-brachial index of 0.65 undergoes diagnostic peripheral angiography that demonstrates severe calcified stenosis of the right common and external iliac artery. After diagnostic angiography, the vascular interventionalist performs endovascular iliac revascularization with angioplasty and stent placement. During the same session, intravascular lithotripsy is used in the right external iliac artery to fracture heavy arterial calcium to facilitate vessel expansion and optimize stent deployment. The procedure includes percutaneous femoral arterial access, fluoroscopic imaging guidance, radiological supervision and interpretation, intravascular lithotripsy catheter use, angioplasty, and placement of an iliac stent. Typical peri-procedure workflow includes pre-procedure consent and assessment, vascular access and baseline angiography, lithotripsy application to the calcified iliac segment, adjunctive balloon angioplasty, stent deployment as indicated, completion angiography, hemostasis, and post-procedure monitoring in an outpatient vascular lab or inpatient interventional suite. Typical site of service: hospital-based angiography/interventional radiology suite or ambulatory surgical center with endovascular capability.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure	Use when a distinct E/M visit is performed and documented the same day as `37262` for a different identifiable problem.
`26`	Professional component	Use if reporting only the physician’s interpretive component of imaging when facility bills technical component separately.
`50`	Bilateral procedure	Use when `37262` is performed bilaterally in the same session and payer allows bilateral modifier application.
`59`	Distinct procedural service	Use to indicate a procedure is distinct or separate from other procedures performed during the same session when clinically appropriate and not bundled.
`76`	Repeat procedure or service by same physician	Use if the same procedure is repeated later the same day by the same provider.
`77`	Repeat procedure by another physician	Use if the procedure is repeated later the same day by a different provider.
`78`	Unplanned return to operating/procedure room by same physician following initial procedure for a related procedure during the postoperative period	Use if patient requires an unplanned return to the procedure suite for a related complication of the initial iliac revascularization.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when the additional procedure is unrelated to the initial procedure’s global period.
`RT`	Right side	Use to append when the procedure is performed on the right iliac artery if payer requires laterality reporting.
`LT`	Left side	Use to append when the procedure is performed on the left iliac artery if payer requires laterality reporting.

Taxonomy Code	Specialty	Notes
`2085R0400X`	Interventional Cardiology	Frequently performs peripheral vascular interventions including iliac interventions.
`207K00000X`	Interventional Vascular Radiology	Common specialty performing iliac angioplasty, stenting, and intravascular lithotripsy.
`2086S0102X`	Vascular Surgery	Vascular surgeons perform endovascular iliac revascularization and manage peri-procedural vascular care.
`363L00000X`	Cardiovascular Disease (general cardiology)	May perform select peripheral interventions in hybrid or cardiac cath lab settings.
`202L00000X`	Diagnostic Radiology	May be involved for imaging guidance and radiological supervision and interpretation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.2`	Atherosclerosis of native arteries of the extremities	Common underlying disease causing iliac artery stenosis requiring revascularization and often associated with calcified plaque addressed by intravascular lithotripsy.
`I70.21`	Atherosclerosis of native arteries of the extremities with intermittent claudication	Typical indication when patients present with exertional limb pain due to iliac stenosis.
`I70.23`	Atherosclerosis of native arteries of the extremities with ulceration	Represents more advanced limb ischemia that may prompt revascularization.
`I70.24`	Atherosclerosis of native arteries of the extremities with gangrene	Severe presentation requiring urgent revascularization.
`I73.9`	Peripheral vascular disease, unspecified	Frequently used when specific laterality or site is not coded but peripheral arterial disease is the clinical problem.
`I65.29`	Occlusion and stenosis of unspecified carotid artery	Not directly iliac but included to note importance of systemic atherosclerotic disease — excluded from billing for iliac procedures unless specifically documented (clinical relevance limited).
`E78.5`	Hyperlipidemia, unspecified	Major risk factor contributing to peripheral arterial disease and calcified lesions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37220`	Revascularization, endovascular, open or percutaneous, iliac artery(ies), initial vessel; endovascular approach	May be reported for the initial iliac revascularization procedure during the same session when stent or angioplasty is performed; `37262` is reported in addition when intravascular lithotripsy is performed in one iliac artery at the same session.
`37221`	Revascularization, endovascular, open or percutaneous, iliac artery(ies), initial vessel; with transluminal stent placement, each vessel	Used when stent placement in an iliac artery is performed as part of the revascularization.
`37224`	Revascularization, endovascular, lower extremity, iliac, femoral, popliteal, tibial, or peroneal artery; with atherectomy	Performed when plaque removal by atherectomy is used; distinct from lithotripsy but may be an adjunct in complex calcified lesions.
`75894`	Radiological supervision and interpretation, angiography, peripheral, therapeutic, initial vessel	Represents radiological S&I for peripheral angiographic therapeutic procedures; imaging S&I for procedures like `37262` is typically included per the code description, but this code may be relevant when separate radiology billing occurs.
`36011`	Introduction of catheter, arterial, percutaneous, for diagnostic or interventional angiography, each vessel catheterized	Represents arterial access and catheter introduction often performed at the start of peripheral angiographic procedures leading to `37262`.