Summary & Overview

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

CPT code 37276 represents a same-session endovascular intervention in which a clinician performs atherectomy and stent placement, with or without angioplasty, for a straightforward stenotic lesion in an additional femoral or popliteal vessel during the same encounter as an initial femoral/popliteal revascularization. The code matters nationally because peripheral arterial disease interventions are common and resource-intensive, and bundling of multiple vascular interventions in a single session has implications for billing, operative planning, and payer coverage determinations. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise explanation of the clinical service captured by the code, the typical sites of service where it is performed, and the common billing and policy considerations that affect payment for combined peripheral vascular procedures. The publication summarizes payer coverage patterns and benchmarks for similar endovascular services, highlights relevant coding and documentation elements associated with multi-vessel sessions, and provides clinical context about when combined atherectomy and stent deployment in the femoral/popliteal territory is used. Data not available in the input are noted where applicable; the focus remains on national-level relevance rather than jurisdiction-specific rules.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare37276CPTperipheral-arterial-diseaseatherectomystent-placementfemoral-poplitealendovascularvascular-surgery

Billing Code Overview

CPT code 37276 describes an endovascular procedure performed in the same session as an initial femoral/popliteal revascularization where the clinician performs atherectomy and stent placement, with or without angioplasty, for a straightforward lesion in an additional vessel within the femoral and popliteal vascular territory. This territory includes the common femoral/profunda femoris and the superficial femoral/popliteal arteries. The service includes all access, catheterization, lesion crossing, and imaging guidance. The approach may be open or percutaneous.

Service type: Combined endovascular atherectomy and stent deployment in an additional femoral/popliteal vessel during the same session as initial revascularization.

Typical site of service: Hospital outpatient department or ambulatory surgery center, and may also occur in hybrid operating rooms where open or percutaneous vascular procedures are performed.

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with a history of peripheral artery disease, hypertension, hyperlipidemia, and tobacco use presents with lifestyle-limiting right lower-extremity claudication and an ankle-brachial index of 0.65. Duplex ultrasound and CT angiography demonstrate a significant, focal stenotic lesion in the superficial femoral artery (SFA) and a separate straightforward stenosis in the popliteal artery. The interventional team schedules an endovascular revascularization procedure. At the same session as the initial femoral/popliteal revascularization service, the operator performs directional atherectomy to remove plaque and then deploys a self-expanding stent in the additional femoral/popliteal vessel; angioplasty may also be used for lesion preparation or post-dilation. The procedure includes percutaneous arterial access, catheter-based diagnostic angiography, lesion crossing, intraprocedural fluoroscopic imaging and intravascular imaging as indicated, atherectomy device use, stent deployment, and hemostasis at the access site. The patient is monitored in the recovery area and discharged the same day with antiplatelet therapy per institution protocol and scheduled follow-up for vascular duplex surveillance.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician interpretation portion of a service provided with separate facility imaging.
`50`	Bilateral procedure	Use when identical procedures are performed on both lower extremities during the same operative session.
`59`	Distinct procedural service	Use when procedures that are normally bundled are performed on separate anatomic sites or are distinct and separate from the primary service.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day for the same patient.
`77`	Repeat procedure by another physician	Use when a second physician repeats the procedure later the same day.
`78`	Return to the operating/procedure room for a related procedure during the postoperative period	Use when an unexpected complication requires a return to the OR/procedure room during the global period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated service is performed during the global period.
`GT`	Via interactive audio and video telecommunication (Medicare)	Use when portions of evaluation or consent are completed via real-time telehealth modalities per payer policy.
`G0`	Telehealth: waiver of certain Medicare telehealth restrictions	Use per payer/Medicare guidance for telehealth encounters when applicable.
`XE`	Separate encounter, a different encounter (X modifier)	Use when a service is distinct by encounter from other services on the same day.
`XS`	Separate structure (X modifier)	Use when the service involves a separate anatomic structure from other same-day services.
`XP`	Separate practitioner (X modifier)	Use when a different practitioner performs a distinct service the same day.
`RT`	Right side	Use to designate the right extremity when the procedure is limited to that side.

Taxonomy Code	Specialty	Notes
207P00000X	Interventional Cardiology / Vascular Medicine	Operators who perform peripheral endovascular interventions including atherectomy and stenting.
207K00000X	Vascular Surgery	Common specialty performing femoral/popliteal endovascular and hybrid procedures.
208000000X	Radiology (Diagnostic) / Interventional Radiology	Vascular interventional radiologists performing catheter-based arterial procedures.
207L00000X	Cardiovascular Surgery	Surgeons who perform endovascular peripheral interventions and hybrid open/endovascular approaches.
364S00000X	Physician Assistant	Allied provider often involved in peri-procedural care and documentation (billing taxonomy for supervising physician required).

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 revascularization and atherectomy/stent placement.
`I70.214`	Atherosclerosis of native arteries of left leg with intermittent claudication	Same as above for the contralateral limb.
`I70.22`	Atherosclerosis of native arteries of extremities with rest pain	Indicates more severe peripheral ischemia often prompting endovascular intervention.
`I70.231`	Atherosclerosis of native arteries of right leg with ulceration	Peripheral arterial disease complication that may require revascularization to promote healing.
`I70.0`	Atherosclerosis of aorta	May coexist in patients with diffuse atherosclerotic disease; relevant to procedural planning.
`I73.9`	Peripheral vascular disease, unspecified	General diagnosis used when specific anatomy or symptom detail is not coded but vascular disease is present.
`E78.5`	Hyperlipidemia, unspecified	Contributing risk factor for atherosclerotic disease and revascularization procedures.
`I65.21`	Occlusion and stenosis of right carotid artery	Example of concurrent atherosclerotic disease elsewhere; relevant in cardiovascular risk assessment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37235`	Transcatheter placement of an intravascular stent(s), peripheral artery, initial vessel	May represent stent placement in the primary target vessel; used when stenting is performed and billed separately for an initial vessel.
`37236`	Transcatheter placement of an intravascular stent(s), peripheral artery, each additional vessel	Used when additional stent placement is performed in a separate vessel during the same session; may be reported in multi-vessel interventions.
`37227`	Revascularization, endovascular, open or percutaneous, femoral/popliteal, initial vessel; with atherectomy, percutaneous	Represents atherectomy for an initial femoral/popliteal vessel—used when atherectomy is performed on the primary treated vessel.
`37276`	At the same session as an initial femoral/popliteal revascularization service, atherectomy and stent placement for a straightforward lesion in an additional vessel	The primary code for concurrent atherectomy plus stent deployment in an additional femoral/popliteal vessel as described.
`36215`	Selective catheter placement, arterial system; each first-order abdominal, pelvic, or lower extremity branch vessel	May be billed for selective catheterization if separate from bundled diagnostic angiography and not included in the primary service.
`76937`	Ultrasound guidance for vascular access; arterial or venous cannulation for diagnostic or therapeutic procedure	May be reported when ultrasound guidance is used for arterial access if payer allows separate reporting.