CPT 37266 Complex Femoral/Popliteal Angioplasty Reimbursement | OpenPayer

Summary & Overview

CPT 37266: Complex Femoral/Popliteal Angioplasty (Add-on)

Headline: CPT code 37266 covers add-on complex angioplasty for femoral/popliteal occlusions

Lead: CPT code 37266 represents angioplasty (balloon expansion) of a complex lesion — specifically a complete occlusion — in an additional vessel within the femoral and popliteal vascular territory when performed in the same session as an initial femoral or popliteal revascularization. The code includes all access, catheterization, lesion crossing, and imaging guidance and may be performed via open or percutaneous approach.

What this code represents and why it matters nationally: This add-on CPT code captures clinically complex, resource-intensive interventions used to treat occlusive peripheral arterial disease in the lower extremity. Proper use affects clinical documentation, facility and professional billing, and national utilization and cost reporting for peripheral vascular interventions.

Key payers covered: This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

What readers will learn: The publication explains clinical context for treating femoral and popliteal occlusions, coding scope for same-session additional-vessel complex angioplasty, and the typical settings where the procedure is performed. It also provides benchmarking and policy context relevant to reimbursement and coverage practices across major payers and Medicare.

Additional notes: Data not available in the input for payer-specific modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service-line mapping.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 37266peripheral vascular interventionfemoral popliteal angioplastyendovascular proceduresadd-on codevascular surgeryangioplasty occlusionhospital outpatient

Billing Code Overview

CPT code 37266 describes angioplasty of a complex lesion (complete occlusion) in an additional vessel within the femoral and popliteal vascular territory performed at the same session as an initial femoral or popliteal revascularization. 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: Add-on complex angioplasty performed during the same session as an initial femoral or popliteal revascularization

Typical site of service: Hospital-based vascular procedure areas or ambulatory surgical centers where femoral/popliteal revascularization is performed

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with progressive right lower-extremity claudication, non-healing toe ulcer, and rest pain is evaluated for peripheral arterial disease. Noninvasive testing (ABI, duplex ultrasound) and diagnostic angiography demonstrate multi-segment disease in the femoral-popliteal territory with a primary target lesion treated by an initial femoral or popliteal revascularization (open femoral endarterectomy or percutaneous transluminal angioplasty/stent of the index vessel). During the same session, the operator identifies a second complex lesion consisting of a chronic total occlusion (CTO) in an additional femoral or popliteal vessel. The provider performs balloon angioplasty of that additional complex lesion, including all arterial access, catheterization, lesion crossing maneuvers, guidewire and catheter use, and fluoroscopic imaging guidance required to complete the procedure. The patient is managed in an interventional suite or hybrid operating room with vascular surgery and interventional radiology capabilities, monitored for hemodynamic stability, access-site hemostasis, and distal perfusion post-procedure. Typical peri-procedural workflow includes informed consent, anticoagulation and/or antiplatelet management per institutional protocol, angiographic imaging, the index revascularization procedure, and the additional angioplasty of the complex lesion billed under 37266 during the same session.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service by the same physician on the day of a procedure

CPT 37239: Secondary Venous Stent Insertion, Endovascular

CPT-37279-FEMORAL-POPLITEAL-INTRAVASCULAR-LITHOTRIPSY

CPT 37279: Intravascular Lithotripsy During Femoral/Popliteal Revascularization

CPT-37262-ILIAC-INTRAVASCULAR-LITHOTRIPSY-DURING-REVASCULARIZATION

CPT 37262: Intravascular Lithotripsy During Iliac Revascularization

CPT-37281-TIBIAL-PERONEAL-ANGIOPLASTY-ADDITIONAL-VESSEL

CPT 37281: Angioplasty of Additional Tibial/Peroneal Vessel

CPT-37246-PERCUTANEOUS-BALLOON-ANGIOPLASTY-ARTERY

CPT 37246: Percutaneous Balloon Angioplasty of an Artery

CPT-37259-ILIAC-ARTERY-STENT-PLACEMENT-ADDITIONAL-VESSEL

CPT 37259: Iliac Artery Stent Placement, Additional Vessel

CPT-37277-ATHERECTOMY-STENT-FEMORAL-POPLITEAL-OCCLUSION

CPT 37277: Atherectomy and Stent Placement for Femoral–Popliteal Occlusion

CPT-37237-ADD-ON-ENDOVASCULAR-STENT-PLACEMENT

CPT 37237: Add-On Endovascular Arterial Stent Placement

CPT-37238-VENOUS-STENT-PLACEMENT-CATHETER

CPT 37238: Venous Stent Placement via Catheter

CPT-37292-TIBIAL-PERONEAL-STENT-AND-ATHERECTOMY-REVASCULARIZATION

CPT 37292: Tibial/Peroneal Revascularization with Stent and Atherectomy

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Taxonomy Code	Specialty	Notes
`207K00000X`	Vascular Surgery	Primary specialty performing open or endovascular femoral/popliteal revascularization and complex angioplasty.
`2080P0207X`	Interventional Cardiology	Performs peripheral endovascular interventions including angioplasty of femoropopliteal lesions in some centers.
`2084P0200X`	Interventional Radiology	Commonly performs peripheral angioplasty and image-guided endovascular therapy.
`2086S0122X`	General Surgery (Vascular focus)	Vascular-focused general surgeons performing femoral-popliteal revascularizations and adjunct angioplasty.
`207L00000X`	Cardiovascular Disease	May perform peripheral interventions in integrated vascular programs (varies by practice).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of extremities, right leg, with intermittent claudication	Atherosclerotic disease causing femoropopliteal stenosis/occlusion treated with `37266`.
`I70.214`	Atherosclerosis of native arteries of extremities, left leg, with intermittent claudication	Left-sided equivalent requiring femoropopliteal intervention.
`I70.231`	Atherosclerosis of native arteries of extremities, right leg, with rest pain	Indicates critical limb ischemia where complex angioplasty of occluded segments may be performed.
`I70.232`	Atherosclerosis of native arteries of extremities, left leg, with rest pain	Left-sided critical ischemia prompting revascularization.
`I70.235`	Atherosclerosis of native arteries of extremities, right leg, with ulceration	Non-healing ulceration from PAD often necessitates multilevel revascularization including `37266`.
`I70.236`	Atherosclerosis of native arteries of extremities, left leg, with ulceration	Left-sided limb-threatening ischemia requiring intervention.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute or subacute occlusion may be managed with endovascular techniques including angioplasty of additional vessels.
`I96`	Gangrene, not elsewhere classified	Advanced ischemic limb disease where revascularization procedures are part of limb salvage efforts.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37246`	Revascularization, endovascular, open or percutaneous, femoral/popliteal artery, single vessel; with transluminal balloon angioplasty	Often represents the initial femoral/popliteal angioplasty procedure performed in the same session; `37266` describes angioplasty of an additional complex occluded vessel at the same session.
`37248`	Transcatheter placement of intravascular stent(s), peripheral arterial, open or percutaneous, initial vessel	May be performed after angioplasty if stent placement is required in the treated femoral or popliteal segment during the same session.
`37267`	At the same session as a femoral or popliteal revascularization service, angioplasty of an additional vessel, simple lesion	Used when the additional vessel lesion is simple rather than complex; distinct from `37266` which is for complex (occlusion) lesions.
`75962`	Transcatheter angiography, selective, limb, unilateral or bilateral, radiological supervision and interpretation	Used to report diagnostic and procedural angiographic imaging performed to guide the endovascular procedures including `37266`.
`35831`	Endarterectomy, femoral	May be the open initial femoral revascularization performed in the same session before performing `37266` on an additional vessel.

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