CPT 37607 AVF Ligation Reimbursement & Policy

CPT code 37607 designates the surgical ligation of an artificially created arteriovenous fistula via incision and application of sutures or clamps to stop blood flow. This procedure is clinically significant for managing complications or unwanted patency of surgically created vascular access, particularly among patients with prior fistula creation for hemodialysis access or other vascular needs. Nationally, CPT 37607 is important where definitive closure of an AV fistula is required to control bleeding, infection risk, high-output cardiac issues, or access-related complications.

Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context of CPT 37607, the typical service setting, and what to expect in coding and billing workflows. The publication summarizes benchmark considerations, common modifiers used with surgical vascular procedures, and clinical indications associated with ligation of an arteriovenous fistula. It also outlines typical places of service and operational considerations relevant to claims processing and coverage determination. Data not available in the input is noted where payer-specific rates, ICD-10 pairings, and provider taxonomy details would normally appear.

Billing Code Overview

CPT code 37607 describes a surgical procedure to locate and ligate an artificially created arteriovenous fistula by making an incision and using sutures or clamps to control or stop blood flow through the fistula. This procedure is a vascular surgical intervention focused on the management of surgically created arteriovenous access.

Service type: Surgical — vascular access ligation

Typical site of service: Operating room, ambulatory surgical center, or other surgical suite

Clinical Context

A typical patient is an adult with an established hemodialysis arteriovenous fistula (AVF) who presents with persistent bleeding, high-output heart failure, recalcitrant infection localized to the fistula, or severe steal syndrome unresponsive to conservative measures. The patient is evaluated in the outpatient vascular surgery clinic or in the hospital by a vascular surgeon or interventionalist. Preoperative assessment includes review of dialysis access history, physical exam of the AVF (bruit, thrill, erythema, drainage), duplex ultrasound to localize the fistula and assess flow, and relevant labs (complete blood count, coagulation profile). After informed consent, the patient is taken to an operating room, ambulatory surgery center, or bedside in select inpatient settings. Under regional or general anesthesia, a targeted incision is made to expose the surgically created AVF; the fistula inflow and outflow are controlled and the fistula is ligated with sutures or clamps to stop flow. Postoperative care includes hemostasis confirmation, wound closure, monitoring for limb ischemia, pain control, and coordination with the patient’s dialysis provider to arrange alternative access or catheter placement as needed. Typical sites of service are the hospital operating room, ambulatory surgery center, or inpatient bedside procedure. The service type is a surgical vascular procedure for termination (ligation) of an arteriovenous fistula used for hemodialysis.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician’s professional component if technical component billed separately.

Taxonomy Code	Specialty	Notes
208000000X	Vascular Surgery	Primary specialty performing AVF ligation and access revision.
207L00000X	Interventional Cardiology/Vascular	Interventional specialists who may perform access-related procedures.
207K00000X	General Surgery	General surgeons with vascular experience who manage dialysis access.
243L00000X	Nephrology	Nephrologists coordinate access care; may perform bedside access procedures in select settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T82.7XXA`	Infection and inflammatory reaction due to other vascular graft and prosthetic devices, initial encounter	AVF infection requiring removal or ligation of the fistula.
`I97.1`	Intraoperative and postprocedural complications and disorders of circulatory system, not elsewhere classified	Complications related to dialysis access prompting ligation.
`I50.9`	Heart failure, unspecified	High-output cardiac failure from AVF may necessitate ligation to reduce flow.
`T81.0XXA`	Hemorrhage and hematoma complicating a procedure, initial encounter	Uncontrolled bleeding from the fistula requiring surgical ligation.
`I70.2`	Atherosclerosis of native arteries of the extremities (if applicable)	Contributes to steal syndrome or ischemia leading to access ligation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36830`	Thrombectomy, open, for dialysis circuit, arterial and/or venous; each vessel	Performed if thrombosis is present prior to or instead of definitive ligation of the AVF.
`36831`	Thrombectomy, open, for dialysis circuit, with revision; each vessel	Performed when salvage or revision of the access is attempted rather than ligation.
`36832`	Revision, dialysis access, with thrombectomy and creation of new anastomosis	Alternative when reconstruction of access is undertaken instead of ligation.
`36620`	Arteriovenous fistula creation, by direct arteriovenous anastomosis, upper arm (e.g., brachiocephalic)	Related prior procedure describing creation of the AVF that may now require ligation.
`36445`	Cannulation of vascular access device, complicated; requiring fluoroscopic guidance or cutdown	Used when alternate access placement or catheter insertion for dialysis is required after ligation.

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Summary & Overview

CPT 37607: Ligation of Artificial Arteriovenous Fistula