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    v1.0.30
    OpenPayerBilling CodesLigation Procedures on Arteries and VeinsCPT cpt-37605-carotid-artery-ligation-open-vascular-surgery
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    CPT 37605: Ligation of Internal or Common Carotid Artery

    Medicare pays $675 on average nationally for this procedure.

    CPT code 37605 describes surgical ligation of the internal or common carotid artery through a neck incision, typically performed for carotid artery aneurysm management; the service is a surgical arterial ligation procedure and is usually performed in an operating room or similar inpatient or hospital-based surgical setting under appropriate anesthesia.

    For related coverage guidance, see recent payer policy updates: Surgical Procedures, Outpatient Surgical Procedures - Site of Service, Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old male with a known symptomatic carotid artery aneurysm presents with neck pain and a pulsatile mass on the right side of the neck. Imaging (CTA of the neck) demonstrates a saccular aneurysm of the right internal carotid artery with risk for rupture and thromboembolic events. Vascular surgery evaluates the patient and recommends open surgical ligation of the affected carotid segment when endovascular repair is unsuitable due to anatomy. The patient is admitted to an inpatient tertiary care center. Preoperative workup includes vascular laboratory studies, cross-sectional imaging review, and anesthesia evaluation. In the operating room under general endotracheal anesthesia, the vascular surgeon makes a cervical incision, dissects to expose the common and internal carotid arteries, and places ligature(s) or vascular clips to occlude flow to the aneurysmal segment. Postoperative care includes neurovascular monitoring, blood pressure control, and imaging follow-up. Typical site of service: inpatient hospital operating room or ambulatory surgery center when clinically appropriate. Service type: open surgical vascular procedure of the neck targeting the internal or common carotid artery (ligation). Typical patient scenario: older adults with carotid aneurysm, carotid blowout risk, or uncontrollable hemorrhage where vessel sacrifice is required.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    37244Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation and imaging guidance; for vessels other than intracranialEndovascular occlusion/embolization may be an alternative to open ligation or used preoperatively to reduce flow to an aneurysm
    36247Selective catheter placement, each first order thoracic neck branch, within the cerebrovascular system; radiological supervision and interpretationDiagnostic or therapeutic angiography to define aneurysm anatomy prior to ligation or embolization
    37184Endovascular repair of aneurysm, extremity or visceral branch, percutaneous, with stent graftNot a direct replacement for carotid ligation but represents endovascular aneurysm repair options when anatomy permits
    61624Ligation or occlusion of extracranial carotid artery (unlisted example for intracranial approaches)Related open surgical vascular codes; illustrates variants of carotid vessel procedures though 37605 specifically describes internal/common carotid ligation
    76937Ultrasound guidance for vascular access and diagnostic intraoperative ultrasoundIntraoperative duplex or ultrasound may be used for localization or assessment of flow before and after ligation

    Related Modifiers

    11 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    207K00000X
    207L00000X
    2086S0122X
    207P00000X
    2083X0100X
    163WN0800X
    207SM0001X

    Related ICD-10-CM Codes

    21 rows

    ICD-10-CM CodeDescription
    G45.8Other transient cerebral ischemic attacks and related syndromes
    G45.9Transient cerebral ischemic attack, unspecified
    H34.03Transient retinal artery occlusion, bilateral
    H34.11Central retinal artery occlusion, right eye
    I63.50Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery
    I63.59Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
    I63.9Cerebral infarction, unspecified
    I65.21Occlusion and stenosis of right carotid artery
    I65.22Occlusion and stenosis of left carotid artery
    I65.23Occlusion and stenosis of bilateral carotid arteries

    Showing 1–10 of 21

    Related Payer Policy Updates

    Specialty: General Surgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01
    Medical Necessity Guidelines — Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Ambulatory Surgery Center (ASC) - Site of Care PolicyKaiser Permanente2026-08-01

    Related Codes

    CPT-37565-INTERNAL-JUGULAR-VEIN-LIGATION-NECK-INCISION

    CPT 37565: Internal Jugular Vein Ligation via Neck Incision

    CPT-37600-EXTERNAL-CAROTID-ARTERY-LIGATION-NECK-SURGERY

    CPT 37600: External Carotid Artery Ligation, Neck Incision

    CPT-37606-CAROTID-ARTERY-LIGATION-NECK

    CPT 37606: Ligation of Internal or Common Carotid Artery

    CPT-37607-ARTERIOVENOUS-FISTULA-LIGATION

    CPT 37607: Ligation of Artificial Arteriovenous Fistula

    CPT-37609-TEMPORAL-ARTERY-LIGATION-ANEURYSM-TREATMENT

    CPT 37609: Temporal Artery Ligation for Aneurysm

    CPT-37615-NECK-ARTERY-LIGATION-TRAUMA

    CPT 37615: Ligation of Ruptured Neck Artery (Traumatic)

    CPT-37616-THORACIC-ARTERY-LIGATION-RUPTURE-TRAUMA

    CPT 37616: Ligation of Ruptured Chest Artery (Trauma)

    CPT-37617-ABDOMINAL-ARTERY-LIGATION-TRAUMA

    CPT 37617: Ligation of Ruptured Abdominal Artery

    CPT-37618-LIGATION-RUPTURED-LIMB-ARTERY-TRAUMA

    CPT 37618: Ligation of Ruptured Limb Artery

    CPT-37619-INFERIOR-VENA-CAVA-LIGATION-VENOUS-SURGICAL-PROCEDURE

    CPT 37619: Inferior Vena Cava Ligation

    Showing 1–10 of 22

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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