Summary & Overview

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

CPT code 37295 defines a same-session tibial or peroneal revascularization in which the provider performs combined stent placement and atherectomy (with optional angioplasty) to treat a complex lesion—such as an occlusion—in an additional vessel within the tibial/peroneal territory (anterior tibial, posterior tibial, peroneal arteries). The procedure includes all access, catheterization, lesion crossing, and imaging guidance and may be performed via percutaneous or open approach. Nationally, this code matters because it captures a complex, resource-intensive peripheral arterial intervention that has implications for hospital resource use, ambulatory surgical center care, and payer coverage policies for limb salvage and chronic limb ischemia care.

Payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of clinical context for tibial and peroneal interventions, the procedural components bundled into the code, and guidance on what to look for in payer coverage and billing workflows. The publication outlines common benchmarks and utilization patterns, highlights key documentation elements that support coding of a same-session combined stent-and-atherectomy procedure, and summarizes relevant policy topics that affect reimbursement and prior authorization practices.

Data not available in the input is noted where applicable, including specific modifiers, associated taxonomies, detailed ICD-10 diagnosis mappings, and related billing codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 37295peripheral arterial interventiontibial revascularizationperoneal arterystent placementatherectomyendovascular surgeryangioplastyvascular surgeryambulatory surgical center

Billing Code Overview

CPT code 37295 describes a same-session tibial or peroneal revascularization procedure in which the provider performs stent placement and atherectomy (plaque removal) in a complex lesion (such as an occlusion) of an additional tibial or peroneal vessel. The tibial and peroneal vascular territory includes the anterior tibial, posterior tibial, and peroneal arteries. The service may also include angioplasty as part of the same complex intervention.

The service type is endovascular and/or open peripheral arterial revascularization involving combined stent placement and atherectomy for a complex tibial or peroneal lesion during the same session as an initial tibial or peroneal revascularization. The description indicates the procedure may be performed via percutaneous or open approach and includes all necessary access, catheterization, lesion crossing, and imaging guidance required to complete the procedure.

The typical site of service for CPT code 37295 is hospital-based vascular interventional suites (including catheterization labs), ambulatory surgical centers, or other procedural settings where endovascular or open peripheral arterial interventions are performed.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with longstanding peripheral artery disease presents with rest pain and a non-healing ischemic foot ulcer affecting the forefoot. Noninvasive testing (ABI and duplex) and diagnostic angiography demonstrate severe multivessel tibial disease: an occluded anterior tibial artery and a complex subtotal stenosis of the posterior tibial artery. In the same operative session as an initial tibial revascularization, the vascular interventionalist performs endovascular revascularization of an additional tibial vessel using atherectomy to debulk plaque followed by stent placement; adjunctive angioplasty may also be performed to optimize lumen gain. The procedure includes arterial access, catheterization, lesion crossing, intraprocedural imaging (fluoroscopy and angiography), and device deployment. Typical workflow includes preprocedural consent and imaging review, sterile vascular access (typically percutaneous femoral or pedal access), diagnostic angiography, lesion crossing with wires/catheters, atherectomy device use, stent deployment in the target tibial vessel, completion angioplasty as needed, hemostasis, and postprocedural monitoring in the recovery area or vascular inpatient unit.

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct procedural service	Use when a separate, distinct procedure is performed during the same session on a different vessel or anatomical site not normally billed together with the primary service.
`76`	Repeat procedure by same physician	Use when the same procedure is repeated subsequent to the original service on the same day by the same provider.
`77`	Repeat procedure by another physician	Use when the same procedure is repeated on the same day by a different physician.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period	Use for an unplanned reintervention in the OR/procedure suite related to the initial tibial revascularization within the global period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when a procedure during the global period is unrelated to the original procedure.
`26`	Professional component	Use when billing only the professional (physician) component of a service that has a technical and professional split for imaging or interpretation.
`TC`	Technical component	Use when billing only the technical component of a service (imaging equipment, technologist) separate from the physician interpretation.
`G0`	Service performed during COVID-19 public health emergency	Use only when applicable under current payer guidance for services related to the public health emergency period.
`52`	Reduced services	Use when a service is partially reduced at the physician’s discretion (for example limited scope of the procedure).
`22`	Increased procedural services	Use when services are substantially greater in work than normally required and documentation supports increased complexity.

Taxonomy Code	Specialty	Notes
`208000000X`	Vascular Surgery	Primary specialty performing open and endovascular lower extremity revascularization.
`208D00000X`	Interventional Cardiology	Cardiology-trained interventionists who perform peripheral endovascular procedures.
`2083P0205X`	Interventional Radiology	Image-guided endovascular interventions in peripheral arteries.
`207RC0000X`	Surgery - Cardiothoracic & Vascular	Surgeons with vascular procedural privileges; performs complex limb salvage procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.241`	Atherosclerosis of native arteries of the extremities with ulceration, right leg	Peripheral atherosclerotic disease causing ischemic foot ulceration often requires tibial revascularization.
`I70.242`	Atherosclerosis of native arteries of the extremities with ulceration, left leg	Indicates limb ischemia with tissue breakdown prompting revascularization to promote healing.
`I70.231`	Atherosclerosis of native arteries of the extremities with rest pain, right leg	Rest pain reflects critical limb ischemia and is an indication for endovascular tibial intervention.
`I70.232`	Atherosclerosis of native arteries of the extremities with rest pain, left leg	Rest pain on the contralateral limb indicating urgent revascularization needs.
`I70.243`	Atherosclerosis of native arteries of the extremities with gangrene, right leg	Severe ischemia with tissue loss/gangrene requiring revascularization for limb salvage.
`I70.244`	Atherosclerosis of native arteries of the extremities with gangrene, left leg	Indicates advanced critical limb ischemia where tibial interventions are part of limb salvage strategy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`34701`	Transcatheter placement of intraluminal stent(s), including angioplasty when performed, for treatment of infrapopliteal artery, percutaneous, single vessel	May be billed for initial tibial stent placement in the index revascularization session if performed in a single vessel prior to additional vessel work; differentiates single-vessel primary service.
`37224`	Revascularization, endovascular, open or percutaneous, radiological supervision and interpretation; tibial/peroneal, initial vessel	Represents an initial tibial or peroneal endovascular revascularization service and may be the primary code in the session when additional complex vessel work is billed with add-on codes.
`37226`	Revascularization, endovascular, open or percutaneous, radiological supervision and interpretation; tibial/peroneal, each additional vessel	Used to report additional tibial/peroneal vessel treatment when simple angioplasty/stenting is performed without the combined stent-plus-atherectomy complexity described in `37295`.
`37184`	Percutaneous transluminal angioplasty, peripheral, artery; tibial, peroneal, pedal (when performed)	Used for angioplasty of tibial/peroneal arteries when performed alone or adjunctively; may be reported when angioplasty is a distinct component not bundled into other codes.
`37296`	At the same session as an initial tibial or peroneal revascularization service, revascularization with atherectomy alone in a complex lesion of an additional tibial/peroneal vessel	Closely related add-on code used when atherectomy alone (without stent placement) is performed on an additional tibial vessel in the same session.