CPT 37299 Inframalleolar Angioplasty Reimbursement | OpenPayer

Summary & Overview

CPT 37299: Inframalleolar Angioplasty for Complex Lesion

CPT code 37299 represents an adjunct angioplasty procedure performed in the inframalleolar vascular territory during the same session as an initial inframalleolar revascularization. It covers angioplasty for a complex lesion—such as a complete occlusion—in an additional inframalleolar vessel (including the dorsalis pedis and plantar arteries) and encompasses all access, catheterization, lesion crossing, and imaging guidance for either an open or percutaneous approach. This code matters nationally because inframalleolar interventions are increasingly used to treat limb-threatening ischemia and complex peripheral arterial disease; accurate coding affects procedure-level reporting, resource utilization, and payment modality for tertiary vascular care.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of clinical context and typical sites of service, a summary of which payers cover this service type, and guidance on which programmatic elements are encapsulated by the code (access, catheterization, lesion crossing, imaging). The publication also outlines benchmarking topics and policy-relevant issues that commonly affect reimbursement and claims processing for complex peripheral vascular procedures. Data not available in the input will be explicitly identified where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare37299CPTinframalleolarangioplastyperipheral-vascularinterventional-radiologyendovascularvascular-surgery

Billing Code Overview

CPT code 37299 describes an angioplasty procedure performed in the inframalleolar vascular territory during the same session as an initial inframalleolar revascularization service. The procedure addresses a complex lesion (such as a complete occlusion) in an additional inframalleolar vessel and includes all access, catheterization, lesion crossing, and imaging guidance required to complete the angioplasty. The inframalleolar territory includes the dorsalis pedis and plantar arteries. The approach may be open or percutaneous.

Service Type: Inframalleolar angioplasty for complex lesion performed during same session as initial revascularization

Typical Site of Service: Hospital operating room, hospital outpatient department, or outpatient vascular/interventional suite

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an older adult with critical limb ischemia or chronic limb-threatening ischemia (rest pain, non-healing foot ulcer, or tissue loss) who previously underwent inframalleolar revascularization during the same session. During the procedure the operator identifies an additional complex occlusion in an inframalleolar vessel (dorsalis pedis or plantar artery) requiring adjunctive balloon angioplasty. The workflow begins with pre-procedure assessment (vascular history, noninvasive testing such as ankle-brachial index, duplex ultrasound, or angiography review), informed consent describing the combined revascularization strategy, and anticoagulation planning. In the angiography suite or hybrid operating room, vascular access is obtained (commonly antegrade femoral or retrograde pedal access), selective catheterization of tibial/pedal vessels is performed, and imaging guidance is used to localize the complex occlusion. Lesion crossing is attempted with guidewires and microcatheters; once the target occluded inframalleolar vessel is crossed, balloon angioplasty of the occluded segment is performed. The service includes all necessary access, catheterization, lesion crossing, and imaging for the additional inframalleolar vessel. Hemostasis is achieved and the patient is monitored post-procedure for limb perfusion, access site complications, and hemodynamic stability. Typical site of service is an endovascular suite, catheterization laboratory, or hybrid operating room; the service may be performed percutaneously or via open approach depending on anatomy and operative plan.

Coding Specifications

Modifier	Description	When to Use
`-26`

CPT 37291: Tibial/Peroneal Atherectomy for Complex Occlusive Lesion

CPT-37284-TIBIAL-PERONEAL-STENT-PLACEMENT-ANGIOPLASTY

CPT 37284: Tibial/Peroneal Stent Placement with Angioplasty

CPT-37267-FEMORAL-POPLITEAL-STENT-PLACEMENT

CPT 37267: Femoral and Popliteal Arterial Stent Placement

CPT-37258-ILIAC-ARTERY-STENT-PLACEMENT-INITIAL-VESSEL-STRAIGHTFORWARD-LESION

CPT 37258: Iliac Artery Stent Placement for Straightforward Lesion

CPT-37276-ATHERECTOMY-STENT-FEMORAL-POPLITEAL-ADDITIONAL-VESSEL

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

CPT-37289-TIBIAL-PERONEAL-ATHERECTOMY-ADDITIONAL-VESSEL

CPT 37289: Atherectomy with Angioplasty in Additional Tibial/Peroneal Vessel

CPT-37286-TIBIAL-PERONEAL-ARTERY-STENT-PLACEMENT-OCCLUSION

CPT 37286: Stent Placement for Tibial/Peroneal Artery Occlusion

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

CPT 37272: Atherectomy of Additional Femoral/Popliteal Lesion

CPT-37270-FEMORAL-POPLITEAL-COMPLEX-LESION-STENT-PLACEMENT

CPT 37270: Stent Placement for Complex Femoral or Popliteal Occlusion

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

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

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Taxonomy Code	Specialty	Notes
`208D00000X`	Vascular Surgery	Primary specialty performing peripheral endovascular and open revascularization procedures.
`208800000X`	Interventional Cardiology	Performs peripheral endovascular interventions including tibial/pedal angioplasty in some centers.
`207RG0100X`	Interventional Radiology	Common operator for percutaneous inframalleolar interventions and image-guided lesion crossing.
`208000000X`	General Surgery	Vascular-trained general surgeons may perform open or hybrid inframalleolar revascularization.
`2084P0800X`	Podiatric Medicine & Surgery	Podiatric surgeons with vascular expertise may perform pedal artery interventions in specialized centers.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.23`	Atherosclerosis of native arteries of extremities with rest pain	Clinical indication for inframalleolar angioplasty to restore perfusion in critical limb ischemia.
`I70.24`	Atherosclerosis of native arteries of extremities with ulceration	Indicates tissue loss/non-healing ulcer that may require inframalleolar revascularization.
`I70.25`	Atherosclerosis of native arteries of extremities with gangrene	Severe ischemia with tissue necrosis often requiring distal revascularization attempts.
`I70.29`	Atherosclerosis of native arteries of extremities with other manifestations	Captures other presentations of peripheral artery disease that may prompt pedal angioplasty.
`I73.9`	Peripheral vascular disease, unspecified	General diagnosis that may be used when detailed PAD staging is not documented but revascularization is performed.
`E11.51`	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	Diabetes is a common contributor to inframalleolar occlusive disease and wound healing impairment.
`L97.909`	Non-pressure chronic ulcer of unspecified part of unspecified lower leg with unspecified severity	A common presenting problem (non-healing ulcer) motivating distal revascularization.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute occlusive events in pedal vessels may be treated with endovascular techniques including angioplasty.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37248`	Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, with transluminal angioplasty	Often performed earlier in the same session to treat tibial disease before inframalleolar angioplasty; may be billed for initial tibial angioplasty.
`37246`	Revascularization, endovascular, open or percutaneous, with transluminal angioplasty, non-coronary, other peripheral arteries	Used for peripheral angioplasty procedures that may involve tibial vessels when specific tibial codes are not appropriate.
`36215`	Selective catheter placement, arterial system; each first order thoracic, abdominal, or pelvic branch, or each major limb artery	May be reported for selective catheterization steps during diagnostic angiography preceding the inframalleolar intervention, depending on payer policy.
`36011`	Introduction of needle and/or catheter into a peripheral artery for diagnostic or therapeutic injection, percutaneous; without subcutaneous port or pump	Used for arterial access in some coding scenarios where separate access reporting is permitted.
`92928`	Percutaneous transluminal coronary angioplasty [included when coronary procedures are performed during the same session]	Not typically directly related but may be present in hybrid cases where concurrent coronary intervention occurs; listed here for workflow awareness.
`76937`	Ultrasound guidance for vascular access (limited)	Commonly used for ultrasound-guided arterial access prior to inframalleolar interventions; billed when documentation supports separate ultrasound guidance service.
`93740`	Venous noninvasive physiologic study, bilateral	May be part of pre-procedure vascular laboratory evaluation when distinguishing arterial vs venous disease; supportive diagnostic service.
`76641`	Ultrasound, arterial, complete duplex scan, extremity studies	Pre-procedure imaging commonly performed to assess limb perfusion and lesion localization prior to inframalleolar angioplasty.

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