CPT 37291 Tibial/Peroneal Atherectomy Reimbursement | OpenPayer

Summary & Overview

CPT 37291: Tibial/Peroneal Atherectomy for Complex Occlusive Lesion

CPT code 37291 denotes an atherectomy, with angioplasty when performed, for a complex occlusive lesion in an additional tibial or peroneal vessel performed in the same session as an initial tibial or peroneal revascularization. The code captures comprehensive intra-procedural work — including access, catheterization, lesion crossing, and imaging guidance — for interventions in the anterior tibial, posterior tibial, and peroneal arteries. This procedure is clinically significant for limb salvage and symptomatic peripheral arterial disease management and has implications for facility and professional billing across outpatient and ambulatory surgical settings.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find national-level context on billing and coding scope for peripheral tibial/peroneal atherectomy, an outline of typical sites of service, and an explanation of what CPT code 37291 represents in clinical workflows. The publication summarizes common reimbursement considerations, coding boundaries relative to initial revascularization services, and how the code integrates into service-line planning for vascular and interventional practices.

The content provides clinicians, billing professionals, and policy analysts with a concise reference to the code's clinical application, payer relevance, and where to look for further operational or payer-specific guidance. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare37291CPTPeripheral VascularAtherectomyTibial PeronealEndovascularVascular SurgeryOutpatient Procedures

Billing Code Overview

CPT code 37291 describes an endovascular procedure performed in the same session as an initial tibial or peroneal revascularization. The service is an atherectomy of a complex lesion (complete blockage or occlusion) in an additional vessel within the tibial and peroneal vascular territory, and it includes angioplasty when performed. This vascular territory comprises the anterior tibial, posterior tibial, and peroneal arteries.

Service type: Peripheral endovascular revascularization — tibial/peroneal atherectomy with possible angioplasty

Typical site of service: Hospital outpatient department or an ambulatory surgical center where peripheral endovascular interventions are performed

Clinical & Coding Specifications

Clinical Context

A typical patient is an older adult with critical limb ischemia or lifestyle-limiting claudication who presents with rest pain, non-healing foot ulceration, or recurrent ischemic symptoms after prior tibial revascularization. Diagnostic workup includes arterial duplex ultrasound and lower extremity angiography showing multilevel tibial-peroneal disease with at least one complex lesion (chronic total occlusion or complete blockage) in an additional tibial or peroneal vessel. During the same session as an initial tibial or peroneal revascularization (for example, percutaneous transluminal angioplasty of one tibial vessel), the interventionalist performs atherectomy with or without adjunctive angioplasty of a separate, complex occluded tibial or peroneal artery (anterior tibial, posterior tibial, or peroneal artery). The clinical workflow includes: pre-procedure consent and vascular access planning, sterile arterial access (commonly via common femoral or contralateral femoral/ipsilateral antegrade approach), diagnostic angiography to delineate lesion anatomy, catheter-based crossing of the occlusion, atherectomy device use to debulk plaque, adjunctive balloon angioplasty as indicated, intraprocedural imaging and hemostasis, and post-procedure monitoring for perfusion and access-site complications. Typical sites of service are hospital-based angiography/vascular interventional suites, ambulatory surgical centers equipped for endovascular procedures, or hybrid operating rooms. Common patient considerations include antiplatelet/anticoagulation management, renal function for contrast use, and limb salvage goals.

Coding Specifications

Modifier	Description	When to Use
`26`

CPT 37296: Inframalleolar Angioplasty (Dorsalis Pedis/Plantar)

CPT-37298-INFRAMALLEOLAR-ANGIOPLASTY-OCCLUSION

CPT 37298: Inframalleolar Angioplasty for Complex Occlusion

CPT-37272-FEMORAL-POPLITEAL-ATHERECTOMY-ADDITIONAL-VESSEL

CPT 37272: Atherectomy of Additional Femoral/Popliteal Lesion

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

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

CPT-37293-TIBIAL-PERONEAL-STENT-ATHERECTOMY-ADDITIONAL-VESSEL

CPT 37293: Tibial/Peroneal Revascularization with Stent and Atherectomy

CPT-37264-FEMORAL-POPLITEAL-ADDITIONAL-VESSEL-ANGIOPLASTY

CPT 37264: Additional-Vessel Femoral/Popliteal Angioplasty

CPT-37285-TIBIAL-PERONEAL-STENT-PLACEMENT-ADD-ON

CPT 37285: Tibial/Peroneal Artery Stent Placement, Add-on

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

CPT 37299: Inframalleolar Angioplasty for Complex Lesion

CPT-37257-ILIAC-ANGIOPLASTY-COMPLEX-LESION-ADDITIONAL-VESSEL

CPT 37257: Iliac Angioplasty for Complex Lesion in Additional Vessel

CPT-37271-PERIPHERAL-ATHERECTOMY-FEMORAL-POPLITEAL

CPT 37271: Peripheral Atherectomy, Femoral/Popliteal Territory

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Taxonomy Code	Specialty	Notes
`2084P0200X`	Cardiovascular Disease (Interventional Cardiology)	Interventional cardiologists frequently perform peripheral endovascular interventions in some centers
`207P00000X`	Vascular Surgery	Vascular surgeons commonly perform tibial/peroneal atherectomy and adjunctive angioplasty for limb salvage
`363A00000X`	Diagnostic Radiology (Interventional Radiology)	Interventional radiologists perform peripheral arterial interventions including tibial/peroneal atherectomy
`207K00000X`	General Surgery	General surgeons with vascular training may perform open and endovascular limb revascularization
`2086S0121X`	Interventional Cardiology - Peripheral Vascular	Providers with peripheral interventional focus who perform complex tibial procedures

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.23`	Atherosclerosis of native arteries of the extremities with rest pain	Common presentation indicating critical limb ischemia requiring tibial/peroneal revascularization and possible atherectomy
`I70.24`	Atherosclerosis of native arteries of the extremities with ulceration	Indicates tissue loss or non-healing ulcer that often prompts endovascular tibial interventions for limb salvage
`I70.25`	Atherosclerosis of native arteries of the extremities with gangrene	Severe ischemia where tibial/peroneal revascularization including atherectomy may be performed to attempt limb salvage
`I70.31`	Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain	Represents restenosis or occlusion in bypass grafts affecting tibial runoff; may necessitate additional tibial interventions
`I73.9`	Peripheral vascular disease, unspecified	General peripheral arterial disease diagnosis that may be used when specifying symptoms and treatment for endovascular procedures
`E11.51`	Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene	Diabetes-related peripheral vascular disease is a frequent comorbidity contributing to tibial/peroneal occlusive disease and need for atherectomy
`R02`	Gangrene, not elsewhere classified	Clinical finding that often correlates with severe limb ischemia prompting revascularization procedures

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37220`	Revascularization, endovascular, open or percutaneous, tibial/ peroneal, initial vessel; includes angioplasty and stent when performed	May represent the initial tibial or peroneal revascularization service performed in the same session as `37291`; `37291` is reported when atherectomy (with angioplasty if performed) is performed in an additional complex tibial/peroneal vessel during the same session
`37235`	Transcatheter placement of intravascular stent(s), cervical or intracranial, initial vessel — (note: vascular stent codes for peripheral below-the-knee stenting often use other codes such as `37224`/`37225` for femoropopliteal; included here for device context)	Stent placement in tibial vessels may be coded separately when performed for residual stenosis after atherectomy/angioplasty; coder must use appropriate below-the-knee stent CPT when applicable
`37224`	Revascularization, endovascular, femoral/popliteal, single vessel	Performed when simultaneous or staged treatment of more proximal femoropopliteal disease is required during the same hospitalization; addresses inflow lesions that affect tibial runoff
`36010`	Introduction of needle or catheter into peripheral artery for diagnostic angiography	Diagnostic arterial access/angiography performed as part of the procedure; often bundled but relevant when separate diagnostic catheterization is reported under specific circumstances
`76937`	Ultrasound, guidance for vascular access (e.g., peripheral)	Often used at the time of arterial access to minimize complications; may be reported separately if not included in global procedure payment
`37291`	Atherectomy in a complex lesion of an additional tibial/peroneal vessel performed at the same session as an initial tibial or peroneal revascularization	Primary code for the described service; includes access, catheterization, lesion crossing, imaging guidance, and atherectomy with angioplasty when performed

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