CPT 37265 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

CPT 37265: Angioplasty of Complex Femoral-Popliteal Occlusive Lesion

CPT code 37265 represents angioplasty (balloon dilation) of a complex occlusive lesion in the femoral and popliteal arterial territory, covering procedures in the common femoral/profunda femoris and superficial femoral/popliteal vessels. The code includes all access, catheterization, lesion crossing, and imaging guidance required to perform the intervention, and applies to either percutaneous or open approaches. This procedure is a core component of peripheral arterial disease management and has national relevance due to the prevalence of lower-extremity arterial occlusive disease and the resource intensity of endovascular interventions.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for utilization and reimbursement patterns across major payers, clinical context on when a complex femoral-popliteal angioplasty is reported, and relevant policy considerations affecting coverage and site-of-service determinations. The publication outlines typical settings where the service is performed (hospital outpatient departments, operating rooms, and interventional suites) and summarizes implications for billing and care coordination. Data not available in the input is explicitly noted where detailed payer-specific rates, modifiers, taxonomies, and diagnosis code mappings would otherwise be expected.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare37265CPTperipheral-angioplastyfemoral-poplitealendovascularinterventional-radiologyvascular-surgery

Billing Code Overview

CPT code 37265 describes percutaneous or open angioplasty (balloon dilation) of a complex occlusive lesion in the femoral and popliteal arterial territory. The procedure targets an initial vessel in the common femoral/profunda femoris or superficial femoral/popliteal arteries and is used to re-establish blood flow through a narrowed or completely occluded arterial segment.

Service type: Endovascular or open peripheral arterial intervention (angioplasty of a complex lesion).

Typical site of service: Hospital outpatient department or inpatient operating room; may also be performed in an endovascular suite or interventional radiology suite for percutaneous approaches.

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with a history of peripheral arterial disease, tobacco use, hypertension, and hyperlipidemia presents with progressive right lower-extremity claudication and rest pain. Noninvasive vascular testing (ABI, arterial duplex ultrasound) and CT angiography demonstrate a chronic total occlusion of the right superficial femoral artery extending into the proximal popliteal segment with collateralization and hemodynamically significant stenoses. The patient is scheduled for endovascular revascularization.

The interventional vascular specialist performs 37265 — angioplasty of a complex femoral/popliteal occlusion — using percutaneous common femoral arterial access. The workflow includes pre-procedure imaging review, ultrasound-guided vascular access, diagnostic angiography to define lesion length and runoff, lesion crossing using wires and support catheters (with potential re-entry devices or subintimal techniques), balloon angioplasty of the occluded segment (and provisional stent placement if required, coded separately), and completion angiography to document flow. Hemostasis is achieved with manual compression or a closure device. The procedure may occur in an outpatient endovascular suite, ambulatory surgery center, or inpatient interventional radiology/cardiac catheterization lab depending on clinical status and payor requirements.

Coding Specifications

Modifier	Description	When to Use
`25`

CPT 37278: Atherectomy and Stent Placement for Additional Femoral/Popliteal Lesion

CPT-37260-ILIAC-ARTERY-STENT-PLACEMENT-COMPLETE-OCCLUSION

CPT 37260: Iliac Artery Stent Placement for Occlusive Lesion

CPT-37298-INFRAMALLEOLAR-ANGIOPLASTY-OCCLUSION

CPT 37298: Inframalleolar Angioplasty for Complex Occlusion

CPT-37287-TIBIAL-PERONEAL-STENT-PLACEMENT-ADDITIONAL-VESSEL

CPT 37287: Tibial/Peroneal Stent Placement During Index Revascularization

CPT-37296-INFRAMALLEOLAR-ANGIOPLASTY-BALLOON-DILATION

CPT 37296: Inframalleolar Angioplasty (Dorsalis Pedis/Plantar)

CPT-37293-TIBIAL-PERONEAL-STENT-ATHERECTOMY-ADDITIONAL-VESSEL

CPT 37293: Tibial/Peroneal Revascularization with Stent and Atherectomy

CPT-37271-PERIPHERAL-ATHERECTOMY-FEMORAL-POPLITEAL

CPT 37271: Peripheral Atherectomy, Femoral/Popliteal Territory

CPT-37274-FEMORAL-POPLITEAL-ATHERECTOMY-ADDITIONAL-VESSEL-OCCLUSION

CPT 37274: Femoral/Popliteal Atherectomy for Complex Occlusive Lesion

CPT-37261-ILIAC-STENT-PLACEMENT-ADDITIONAL-VESSEL

CPT 37261: Stent Placement in Additional Iliac Vessel During Initial Revascularization

CPT-37269-FEMORAL-POPLITEAL-COMPLEX-OCCLUSION-STENT-PLACEMENT

CPT 37269: Stent Placement for Complex Femoral-Popliteal Occlusion

Showing 1–10 of 32

Taxonomy Code	Specialty	Notes
207RH0000X	Interventional Cardiology	Interventional cardiologists perform peripheral angioplasty of femoropopliteal lesions in many centers.
207RG0100X	Vascular Surgery	Vascular surgeons commonly perform open or endovascular femoropopliteal interventions including `37265`.
310400000X	Interventional Radiology	Interventional radiologists frequently perform percutaneous lesion crossing and angioplasty in the femoral/popliteal territory.
2086S0123X	General Surgery - Vascular	General surgeons with vascular practice perform peripheral angioplasty procedures.
207L00000X	Cardiology	Clinical cardiologists with peripheral interventional skill sets may perform these procedures in selected settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of extremities, bilateral legs, with intermittent claudication	A common cause of femoropopliteal disease prompting angioplasty such as `37265`.
`I70.221`	Atherosclerosis of native arteries of extremities, right leg with rest pain	Indicates critical limb ischemia in the right leg where `37265` may be indicated.
`I70.233`	Atherosclerosis of native arteries of extremities, left leg with ulceration	Ulceration from PAD can necessitate revascularization of femoropopliteal occlusions.
`I70.24`	Atherosclerosis of native arteries of right leg with gangrene	Severe manifestation where femoropopliteal intervention may be attempted for limb salvage.
`I73.9`	Peripheral vascular disease, unspecified	General diagnosis often used when documenting PAD as the indication for `37265`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36245`	Selective catheter placement, arterial system, extremity, with diagnostic angiography, initial vessel	Performed prior to or during `37265` to selectively catheterize the femoral/popliteal vessels for diagnostic imaging and guidewire access.
`75962`	Transcatheter occlusion angiography and pressure measurements (intra-arterial)	Used when pressure gradients across the lesion are measured intra-procedurally to assess hemodynamic significance adjunctive to `37265`.
`37236`	Revascularization, endovascular, open or percutaneous, femoral-popliteal artery, single vessel; with transluminal stent placement	Reported when stent deployment is performed in addition to angioplasty of the femoropopliteal segment during the same session (stent codes are separate from `37265`).
`35476`	Amputation, toe; metatarsal - partial (example of downstream consequence code)	May be billed in separate episodes of care if limb salvage fails despite `37265`; included here as related downstream procedural context.
`93662`	Comprehensive electrophysiologic evaluation with right and left heart catheterization (example cath lab utilization)	Represents complex cath lab procedures often sharing facility resources and workflow with peripheral interventions like `37265`.

OpenPayer