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CPT 37264: Additional-Vessel Femoral/Popliteal Angioplasty

CPT code 37264 covers angioplasty of a straightforward stenotic lesion in an additional femoral or popliteal vessel performed during the same session as an initial femoral or popliteal revascularization. This code captures the bundled work of access, catheterization, lesion crossing, imaging guidance, and the angioplasty procedure itself, and applies whether the approach is open or percutaneous. Nationally, the code matters because it delineates payment and reporting for multi-vessel peripheral interventions during a single operative session, affecting facility and professional billing practices across hospital outpatient departments, inpatient settings, and ambulatory endovascular labs.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service definition, plus discussion of payer coverage patterns and benchmark considerations where available. The publication summarizes coding intent, common utilization scenarios, and the implications for coding and billing workflows when additional-vessel angioplasty is performed at the same session as initial femoral/popliteal revascularization. Data not available in the input is noted where payer-specific policies, modifiers, taxonomies, ICD-10 linkages, and related codes would normally be detailed.

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Billing Code Overview

CPT code 37264 describes angioplasty (balloon expansion) of a straightforward lesion in an additional vessel in the femoral and popliteal vascular territory performed at the same session as an initial femoral or popliteal revascularization service. The territory includes the common femoral/profunda femoris and the superficial femoral/popliteal arteries. The service includes all access, catheterization, lesion crossing, and imaging guidance required to complete the procedure. The approach may be open or percutaneous.

Service type: Peripheral vascular intervention (additional-vessel angioplasty during the same session as initial femoral or popliteal revascularization)
Typical site of service: Hospital-based vascular suite, inpatient operating room, or outpatient endovascular/interventional radiology lab

Find policies, billing codes, payers, states, and providers

CPT 37264: Additional-Vessel Femoral/Popliteal Angioplasty

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Get alerted when payer policies referencing 37264 are released or updated.

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Billing Code Overview

Service type: Peripheral vascular intervention (additional-vessel angioplasty during the same session as initial femoral or popliteal revascularization)
Typical site of service: Hospital-based vascular suite, inpatient operating room, or outpatient endovascular/interventional radiology lab

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with smoking history, peripheral arterial disease, and lifestyle-limiting right calf claudication is referred to vascular surgery after noninvasive testing demonstrates a hemodynamically significant stenosis of the right superficial femoral artery (SFA). During the same session as an initial femoral revascularization (open or percutaneous) to treat the primary lesion in the SFA, the interventionalist identifies a second, straightforward focal stenosis in the profunda femoris artery within the femoral/popliteal vascular territory. The provider performs balloon angioplasty of that additional lesion during the same anesthetic encounter.

Pre-procedure workflow includes vascular lab imaging, medication reconciliation (antiplatelet and anticoagulation assessment), informed consent specific to endovascular femoral/popliteal interventions, and planning of access site (common femoral artery access or open cutdown). Intra-procedure steps include arterial access, catheter and sheath placement, lesion crossing, selective angiography for lesion characterization, balloon dilation of the additional vessel, and completion angiography. Post-procedure workflow includes hemostasis management, monitoring for access complications, assessment of distal perfusion, discharge instructions regarding antiplatelet therapy and wound care, and scheduling follow-up vascular clinic and duplex surveillance.

Coding Specifications

Modifier	Description	When to Use
`-25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	Use when a medically necessary E/M visit distinct from the procedure is provided on the same day.

-26 | Professional component | Use when billing only the physician’s professional component for imaging or other services.

-50 | Bilateral procedure | Use when the angioplasty is performed bilaterally and the payer requires the bilateral modifier instead of separate line items.

-59 | Distinct procedural service | Use when procedures that are normally bundled need to be reported separately because they are distinct and unrelated.

-62 | Two surgeons | Use when two surgeons from different specialties share responsibility for the procedure.

-77 | Repeat procedure by same physician | Use when an identical procedure is repeated later by the same physician during the postoperative period.

-78 | Return to operating room for a related procedure during the global period | Use when an unplanned return to the operating room for a related procedure occurs during the global period.

-79 | Unrelated procedure or service by same physician during global period | Use when a procedure unrelated to the original surgery is performed during the global period.

-RT | Right side | Use to designate procedures performed on the right side when payer requires laterality modifiers.

-LT | Left side | Use to designate procedures performed on the left side when payer requires laterality modifiers.

Taxonomy Code	Specialty	Notes
`208800000X`	Vascular Surgery	Primary specialty performing femoral/popliteal revascularization and angioplasty.

2086S0200X | Interventional Cardiology | Performs peripheral endovascular interventions in many centers.

207RG0300X | Interventional Radiology | Frequently performs percutaneous femoral and popliteal angioplasty and image-guided procedures.

2084P0800X | General Surgery | Vascular-focused general surgeons may perform open or hybrid femoral revascularization.

2080S0003X | Cardiovascular Disease | May be involved when catheter-based peripheral interventions are performed by cardiologists.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of right leg with intermittent claudication	Common indication for femoral/popliteal angioplasty to relieve symptomatic stenosis.

I70.214 | Atherosclerosis of native arteries of left leg with intermittent claudication | Same as above for the left limb when procedure is performed on that side.

I70.241 | Atherosclerosis of native arteries of right leg with rest pain | Indicates more severe ischemia prompting revascularization.

I70.242 | Atherosclerosis of native arteries of left leg with rest pain | Indicates severe limb ischemia on the left side.

I70.23 | Atherosclerosis of native arteries of right leg with ulceration | Peripheral arterial disease with tissue loss may necessitate revascularization to promote wound healing.

I70.24 | Atherosclerosis of native arteries of left leg with ulceration | As above for the left extremity.

I74.3 | Embolism and thrombosis of arteries of lower extremities | May present as acute limb ischemia requiring urgent endovascular intervention including angioplasty.

I73.9 | Peripheral vascular disease, unspecified | General diagnosis used when PAD is present but not further specified; often accompanies procedural indications.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37246`	Transcatheter placement of intravascular stent(s), peripheral artery, open or percutaneous, including angioplasty when performed; initial vessel	May be performed if angioplasty alone is insufficient and a stent is required in the primary treated vessel.

37267 | Transcatheter placement of an intravascular stent(s), peripheral artery, with atherectomy when performed; initial vessel | Performed when plaque debulking (atherectomy) is needed in conjunction with stent placement during the revascularization session.

37225 | Revascularization, endovascular, open or percutaneous, femoral/popliteal, initial vessel; with transluminal angioplasty | Represents the initial femoral or popliteal revascularization service commonly reported with 37264 for the additional vessel in the same session.

36011 | Introduction of needle or intracatheter, arterial, cutdown, not including imaging guidance | May be reported for arterial cutdown access techniques when performed separately from percutaneous access.

76937 | Ultrasound guidance for vascular access (e.g., duplex ultrasound) | Used when real-time ultrasound guidance is used for arterial access prior to angioplasty or revascularization.

CPT 37252: Intravascular Ultrasound for Noncoronary Vessel

CPT-37253-INTRAVASCULAR-ULTRASOUND-NONCORONARY-ADD-ON

CPT 37253: Intravascular Ultrasound for Additional 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-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

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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.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`-25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	Use when a medically necessary E/M visit distinct from the procedure is provided on the same day.