CPT 37274 Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 37274: Femoral/Popliteal Atherectomy for Complex Occlusive Lesion

CPT code 37274 denotes an atherectomy (with possible angioplasty) of a complex, occlusive lesion in an additional femoral or popliteal vessel performed during the same session as an initial femoral or popliteal revascularization. The code captures a bundled procedural service that includes access, catheterization, lesion crossing, and imaging guidance, and applies whether the approach is percutaneous or open. It is nationally relevant because it reflects management of advanced peripheral arterial disease and can affect episode-level reimbursement, utilization reporting, and quality measurement for vascular services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and procedural scope for 37274, an explanation of typical sites of service, and a summary of payer coverage patterns and benchmarking considerations where available. The publication also outlines common coding relationships, associated service lines, and points of attention for claims adjudication and documentation. This summary is intended for clinicians, billing professionals, and policy analysts seeking a national-level reference for coding and classification of complex femoral/popliteal atherectomy procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare37274CPTPeripheral VascularAtherectomyEndovascularFemoral ArteryPopliteal ArteryVascular SurgeryInterventional Radiology

Billing Code Overview

CPT code 37274 describes an intra-procedural atherectomy of a complex lesion (chronically occluded or completely blocked) performed in an additional vessel of the femoral and popliteal vascular territory during the same session as an initial femoral or popliteal revascularization. The femoral and popliteal vascular territory includes the common femoral/profunda femoris and the superficial femoral/popliteal arteries. The service encompasses all access, catheterization, lesion crossing, imaging guidance, and may include adjunctive angioplasty. The approach can be open or percutaneous.

Service type: Peripheral endovascular intervention (atherectomy with possible angioplasty) performed during the same session as an initial femoral or popliteal revascularization
Typical site of service: Hospital-based vascular interventional suite or operating room, or outpatient endovascular lab where femoral or popliteal revascularization procedures are performed

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with a history of peripheral arterial disease, hypertension, and tobacco use presents with progressive right lower-extremity rest pain and an ischemic ulcer on the forefoot. Noninvasive vascular testing (ABI, arterial duplex) and diagnostic angiography demonstrate a recently treated complex chronic total occlusion of the superficial femoral artery with persistent significant stenosis in an additional femoropopliteal vessel. The vascular interventionalist performs the initial femoral or popliteal revascularization (angioplasty ± stent or atherectomy) and, during the same session, performs an atherectomy of a separate complex occlusive lesion in an additional femoral/popliteal vessel.

The clinical workflow includes pre-procedure evaluation (history, anticoagulation review, informed consent), vascular access (common femoral or alternative percutaneous/open access), diagnostic angiography to map lesions, lesion crossing techniques, atherectomy device deployment (rotational, directional, or laser as indicated), adjunctive balloon angioplasty or stent placement if required, intraprocedural imaging (fluoroscopy, digital subtraction angiography), hemostasis and access site management, and post-procedure monitoring for limb perfusion and access complications. The service described by 37274 includes all access, catheterization, lesion crossing, and imaging guidance for the additional complex lesion treated in the same session as the initial femoral or popliteal revascularization.

Coding Specifications

Modifier	Description	When to Use

CPT 37265: Angioplasty of Complex Femoral-Popliteal Occlusive Lesion

CPT-37276-ATHERECTOMY-STENT-FEMORAL-POPLITEAL-ADDITIONAL-VESSEL

CPT 37276: Atherectomy and Stent Placement in Additional Femoral/Popliteal Vessel

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-37299-INFRAMALLEOLAR-ANGIOPLASTY-ADDITIONAL-COMPLEX-LESION

CPT 37299: Inframalleolar Angioplasty for Complex Lesion

CPT-37295-TIBIAL-PERONEAL-STENT-ATHERECTOMY-COMPLEX-LESION

CPT 37295: Tibial/Peroneal Stent Placement with Atherectomy, Complex Lesion

CPT-37291-TIBIAL-PERONEAL-ATHERECTOMY-COMPLEX-LESION

CPT 37291: Tibial/Peroneal Atherectomy for Complex Occlusive Lesion

CPT-37278-FEMORAL-POPLITEAL-ATHERECTOMY-STENT-ADDITIONAL-LESION

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

CPT-37284-TIBIAL-PERONEAL-STENT-PLACEMENT-ANGIOPLASTY

CPT 37284: Tibial/Peroneal Stent Placement with Angioplasty

CPT-37297-INFRAMALLEOLAR-ANGIOPLASTY-ADDITIONAL-VESSEL

CPT 37297: Inframalleolar Angioplasty for Additional Vessel, Straightforward Lesion

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Taxonomy Code	Specialty	Notes
`207PX0400X`	Vascular Surgery	Surgeons who perform open and endovascular femoropopliteal interventions.
`208800000X`	Interventional Cardiology	Cardiologists who perform peripheral vascular interventions in some systems.
`2086S0121X`	Interventional Radiology	Radiologists specializing in image-guided peripheral interventions.
`207L00000X`	General Surgery	Surgeons who may perform peripheral vascular procedures in some settings.
`363A00000X`	Vascular Medicine	Clinicians focused on medical management and coordinating interventions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of extremities with rest pain, bilateral legs	Peripheral arterial atherosclerosis causing critical limb ischemia often necessitating femoropopliteal revascularization and atherectomy.
`I70.214`	Atherosclerosis of native arteries of extremities with ulceration, bilateral legs	Ischemic ulceration from peripheral arterial disease indicating need for revascularization procedures.
`I70.233`	Atherosclerosis of native arteries of right leg with rest pain	Laterality-specific code supporting targeted intervention on the right femoropopliteal segment.
`I70.234`	Atherosclerosis of native arteries of left leg with rest pain	Laterality-specific code supporting targeted intervention on the left femoropopliteal segment.
`I74.3`	Embolism and thrombosis of arteries of lower extremity	Acute or subacute arterial occlusion that may require endovascular recanalization including atherectomy if organized thrombus or plaque is present.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37224`	Revascularization, endovascular, open or percutaneous, femoral or popliteal artery, initial vessel; including intraprocedural imaging and all associated catheter-based work	Often reported for the initial femoral or popliteal revascularization service performed in the same session before `37274` is reported for the additional complex lesion.
`37225`	Revascularization, endovascular, femoral or popliteal artery, each additional vessel treated in the same artery; angioplasty, stent, or atherectomy when applicable	May be used for additional non-complex vessels or for reporting multiple treated segments when payer rules differentiate from `37274`.
`37275`	Atherectomy, open or percutaneous, of additional limb arterial segment in the same vascular territory when performed with initial revascularization (not otherwise specified)	Related atherectomy code often referenced in payer edits; confirm payer-specific bundling with `37274`.
`36215`	Selective catheterization, arterial system; each first order thoracic aorta branch (e.g., brachiocephalic, left common carotid)	Diagnostic catheterization codes like `36215` may be used for selective angiography of feeding vessels if separately reportable.
`36010`	Introduction of needle or intracatheter for diagnostic angiography (e.g., arterial puncture)	Codes for vascular access may be billed by facility or provider depending on billing arrangements.
`76937`	Ultrasound guidance for vascular access requiring documentation	Used when ultrasound guidance is documented and billed separately for difficult vascular access.

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