Summary & Overview
CPT 37280: Tibial/Peroneal Balloon Angioplasty, Single Lesion
CPT code 37280 denotes balloon angioplasty of a straightforward stenotic lesion in an initial tibial or peroneal artery (anterior tibial, posterior tibial, or peroneal). It captures the complete endovascular revascularization episode for a single lesion in the tibial/peroneal vascular territory, including access, catheterization, lesion crossing, and imaging guidance. This procedure is clinically important for limb salvage and treatment of peripheral arterial disease affecting the lower extremity and is performed in a range of acute and elective settings.
Key national payers evaluated include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context and typical sites of service, plus an outline of what to expect in payer coverage and billing practice. The publication covers reimbursement benchmarks, common billing challenges, coding nuances for single-lesion tibial/peroneal angioplasty, and relevant policy updates that affect coverage and documentation requirements. Clinical implications for vascular specialists and interventional teams are summarized to frame billing and utilization considerations. Where specific payer policies, modifier usage, associated taxonomies, ICD-10 mappings, or related codes are not provided in the input, the report notes that those data points are not available in the input.
Billing Code Overview
CPT code 37280 describes angioplasty (balloon expansion) of a straightforward stenotic lesion in an initial tibial or peroneal artery (anterior tibial, posterior tibial, or peroneal). The service includes all vascular 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: Endovascular revascularization procedure (peripheral angioplasty) for tibial/peroneal vessels
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Typical site of service: Hospital outpatient department, outpatient vascular lab with interventional capability, or inpatient operating room depending on clinical setting and approach
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with diabetes mellitus and longstanding peripheral arterial disease presents with rest pain and an ischemic ulcer on the distal foot. Noninvasive testing (ABI, duplex ultrasound) and diagnostic angiography demonstrate a focal, straightforward stenosis in the proximal posterior tibial artery within the tibial-peroneal vascular territory. After informed consent, the vascular interventionalist performs a percutaneous transfemoral arterial access, advances diagnostic and guide catheters into the tibial vessels under fluoroscopic guidance, crosses the stenotic lesion with a guidewire, and performs balloon angioplasty of the lesion. The procedure includes vascular access, catheterization, lesion crossing, angiographic imaging, intraprocedural heparinization, and post-dilation angiography to confirm adequate flow and absence of complication. The patient is monitored postprocedure in a recovery area and discharged with wound care and antiplatelet instructions or admitted for ongoing limb salvage care depending on clinical status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing separate physician interpretation of imaging when the facility bills for technical component |
50 |