Summary & Overview
CPT 37263: Femoral and Popliteal Balloon Angioplasty
CPT code 37263 represents angioplasty (balloon dilation) of a straightforward stenotic lesion in an initial vessel of the femoral and popliteal vascular territory. This code captures the full procedure including access, catheterization, lesion crossing, and imaging guidance, and applies to percutaneous and open approaches. Nationally, peripheral endovascular interventions for femoropopliteal disease are common components of vascular care for patients with symptomatic peripheral artery disease and critical limb ischemia; accurate coding supports appropriate clinical documentation and claims processing.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service settings, plus what to expect from payer coverage patterns and common billing considerations. The publication outlines benchmarks used in comparative analyses, recent coding policy clarifications that affect procedural bundling and site-of-service considerations, and related service-line implications for vascular surgery and interventional radiology practices.
This summary is intended to orient clinicians, billing staff, and policy analysts to the clinical scope of the code, typical sites of care, and the payer landscape relevant to CPT code 37263. Data not available in the input for specific modifiers, taxonomies, ICD-10 pairings, and related CPT codes is noted elsewhere in the full publication.
Billing Code Overview
CPT code 37263 describes balloon angioplasty of a straightforward stenotic lesion in an initial vessel of the femoral and popliteal vascular territory (including common femoral/profunda femoris and superficial femoral/popliteal arteries). The procedure includes all vascular access, catheterization, lesion crossing, and imaging guidance required to complete the angioplasty. The approach may be percutaneous or via an open technique.
Service type: Endovascular peripheral angioplasty
Typical site of service: Hospital outpatient department or ambulatory surgical center; may also be performed in an inpatient operating room when clinically indicated
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old man with progressive left calf claudication and reduced walking distance over several months, with risk factors including hypertension, hyperlipidemia, and tobacco use. Noninvasive testing (ABI showing decreased ankle-brachial index and duplex ultrasound demonstrating focal stenosis of the superficial femoral artery) indicates hemodynamically significant peripheral arterial disease of the femoropopliteal segment. The vascular surgeon or interventional radiologist schedules a percutaneous transluminal angioplasty of the femoral/popliteal artery territory.
Pre-procedure workflow includes informed consent, review of anticoagulation, contrast allergy assessment, baseline labs (BMP, CBC, coagulation studies), and vascular access planning. The procedure is performed in an angiography suite or hybrid operating room under local anesthesia with or without conscious sedation. Arterial access is obtained (commonly common femoral artery), catheterization and lesion crossing are completed using guidewires and catheters, and fluoroscopic imaging with contrast is used for lesion localization. Balloon angioplasty of the straightforward lesion in the femoral/popliteal segment is performed; stent placement is not included in the 37263 allowance unless specifically documented and separately reported. Hemostasis is achieved via manual compression, closure device, or open approach as indicated. Post-procedure monitoring includes vascular checks, puncture site evaluation, and discharge instructions for activity and antiplatelet therapy as per institutional protocol.
Coding Specifications
- Modifiers table
| Modifier | Description | When to Use |
|---|