Summary & Overview
CPT 37288: Tibial/Peroneal Atherectomy With Angioplasty
CPT code 37288 represents atherectomy of an initial tibial or peroneal artery lesion, with angioplasty when performed. The code captures comprehensive endovascular care for plaque removal and lesion treatment in the anterior tibial, posterior tibial, and peroneal arteries, including vascular access, catheterization, lesion crossing, and image guidance. Nationally, this code is relevant for peripheral arterial disease management, limb salvage efforts, and procedural coding consistency across vascular surgery and interventional radiology.
Key payers considered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for tibial/peroneal atherectomy, coding scope and procedural elements represented by the code, typical sites of service, and comparisons to related lower-extremity endovascular procedure codes. The publication also summarizes common billing considerations, expected documentation elements implied by the CPT descriptor, and where to look for payer-specific coverage policies and prior authorization pathways.
This national summary is intended to clarify what the code represents, how it fits into peripheral vascular service lines, and what operational and policy topics to review when coding, billing, or developing coverage criteria for tibial and peroneal atherectomy procedures.
Billing Code Overview
CPT code 37288 describes an atherectomy procedure with or without angioplasty performed in a straightforward lesion of an initial tibial or peroneal artery (anterior tibial, posterior tibial, or peroneal arteries). The service encompasses all access, catheterization, lesion crossing, and imaging guidance required to complete the procedure. The approach may be percutaneous or open.
Service type: Endovascular peripheral arterial intervention (atherectomy ± angioplasty) in tibial/peroneal territory
Typical site of service: Hospital outpatient department or ambulatory surgical center; may also occur in inpatient settings when clinically indicated.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with diabetes mellitus and peripheral artery disease presents with progressive rest pain and non-healing ischemic ulcer of the foot. Noninvasive testing (ABI, toe pressures, and duplex ultrasound) demonstrates significant tibial artery stenosis in the anterior tibial artery. The vascular surgery or interventional radiology team schedules an endovascular revascularization procedure involving tibial atherectomy with adjunct balloon angioplasty to debulk calcific plaque and restore inline flow to the foot.
The clinical workflow includes pre-procedure evaluation (consent, antiplatelet/anticoagulation management, imaging review), percutaneous arterial access (commonly common femoral or antegrade tibial approach), catheterization and lesion crossing with guidewire, atherectomy device deployment and plaque removal in the target tibial or peroneal vessel, adjunctive angioplasty as needed, completion angiography to confirm flow, hemostasis and access site closure, and post-procedure monitoring with limb perfusion checks and wound care coordination.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of procedure | Use when a distinct E/M visit is performed on the same day as the procedure and is medically necessary |