Summary & Overview
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.
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.
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Service type: Peripheral vascular intervention (additional-vessel angioplasty during the same session as initial femoral or popliteal revascularization)
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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 |