CPT 37761 Perforator Vein Ligation Reimbursement | OpenPayer

Summary & Overview

CPT 37761: Perforator Vein Ligation and Excision for Varicose Veins

CPT code 37761 represents an ultrasound-guided surgical procedure to treat varicose veins by accessing, excising adjacent diseased tissue, and ligating a perforator vein that connects superficial and deep venous systems. The code captures a targeted operative approach addressing perforator reflux and related venous pathology. Nationally, this procedure is important because it addresses chronic venous insufficiency and symptomatic varicosities that contribute to pain, edema, skin changes, and recurrence if untreated.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise national view of coverage and coding considerations across major commercial payers and the Medicare program.

Readers will find a clear clinical context for the service, the typical sites of care, and what to expect in terms of documentation and code-level description. The report summarizes benchmark topics such as utilization patterns, coverage policy themes, and common coding considerations where available. Data not available in the input is noted explicitly where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare37761CPTvaricose-veinsperforator-vein-ligationvascular-surgeryultrasound-guidedambulatory-surgeryvenous-surgery

Billing Code Overview

CPT code 37761 describes a surgical procedure to treat varicose veins by directly accessing and ligating a perforator vein. The provider makes incisions along the affected superficial vein, opens the overlying fascia, excises diseased adjacent structures, and ligates the targeted perforator vein under ultrasound guidance.

Service type: Surgical vein procedure for treatment of varicose veins (ligation and excision of perforator vein)
Typical site of service: Outpatient surgical suite or hospital outpatient department; may also be performed in an ambulatory surgery center depending on clinical setting and facility capabilities.

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents to a vascular surgery clinic with symptomatic varicose veins of the lower extremity characterized by pain, swelling, skin irritation, and recurrent localized venous stasis changes. Duplex ultrasound identifies incompetent perforator veins communicating between the superficial system and deep veins. After conservative therapy (compression, leg elevation) failed to relieve symptoms, the vascular surgeon schedules a perforator vein ligation and excision under ultrasound guidance (CPT 37761).

The clinical workflow includes pre-procedure evaluation (history, focused vascular exam, duplex ultrasound mapping), informed consent, procedural site marking, sterile preparation, and ultrasound-guided incision(s) over the target perforator(s). The provider incises through the fascia, excises diseased adjacent structures as indicated, and ligates the perforator(s). Hemostasis is confirmed, incisions are closed, and compression dressing applied. Post-procedure instructions address wound care, activity restrictions, compression stocking use, and follow-up duplex imaging as clinically indicated. Typical site of service is an ambulatory surgery center or hospital outpatient department; sedation or general anesthesia may be used based on patient factors and payer policies.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

Related Codes

CPT-37615-NECK-ARTERY-LIGATION-TRAUMA

CPT 37615: Ligation of Ruptured Neck Artery Due to Trauma

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

CPT 37616: Ligation of Ruptured Chest Artery (Trauma)

CPT-37650-FEMORAL-VEIN-LIGATION-UPPER-THIGH

CPT 37650: Femoral Vein Ligation for Varicose Vein

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

CPT 37609: Temporal Artery Ligation for Aneurysm Treatment

CPT-37718-SHORT-SAPHENOUS-VEIN-STRIPPING-VARICOSE-VEINS

CPT 37718: Short Saphenous Vein Stripping for Varicose Veins

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

CPT 37618: Ligation of Ruptured Limb Artery

CPT-37766-PHLEBECTOMY-VARICOSE-VEIN-EXCISION-20-PLUS-INCISIONS

CPT 37766: Excision of Varicose Veins (20+ Small Incisions)

CPT-37617-ABDOMINAL-ARTERY-LIGATION-TRAUMA

CPT 37617: Ligation of Ruptured Abdominal Artery

CPT-37607-ARTERIOVENOUS-FISTULA-LIGATION

CPT 37607: Ligation of Artificial Arteriovenous Fistula

CPT-37605-CAROTID-ARTERY-LIGATION-OPEN-VASCULAR-SURGERY

CPT 37605: Ligation of Internal or Common Carotid Artery

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Taxonomy Code	Specialty	Notes
207P00000X	Vascular Surgery	Primary specialty that commonly performs perforator ligation and excision.
2080P0200X	General Surgery	General surgeons with vascular experience often perform varicose vein surgery.
2081P0200X	Thoracic and Cardiac Surgery (Peripheral Vascular)	Surgeons with peripheral vascular training may perform complex venous procedures.
207K00000X	Interventional Cardiology	Interventionalists performing ultrasound-guided venous interventions in select practices.
207L00000X	Plastic Surgery	Plastic surgeons may perform in combined cases where reconstruction or skin management is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I83.10`	Varicose veins of unspecified lower extremity with pain	Common indication for perforator ligation to address symptomatic reflux.
`I83.211`	Varicose veins of right lower extremity with inflammation	Inflammation and symptomatic disease may prompt surgical ligation of perforators.
`I83.212`	Varicose veins of left lower extremity with inflammation	Laterality-specific code supporting `RT`/`LT` modifiers and procedure targeting.
`I83.813`	Varicose veins of other specified lower extremity with ulceration	Presence of venous ulceration often indicates need for definitive venous surgery including perforator ligation.
`I87.2`	Venous insufficiency (chronic) (peripheral)	Underlying pathophysiology treated by correcting incompetent perforators.
`I83.90`	Varicose veins of unspecified lower extremity without ulcer or inflammation	Elective symptomatic varicosity management may include `37761`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36475`	Ligation, incompetent perforating vein(s), subfascial endoscopic; single limb	Alternative minimally invasive/endoscopic approach to perforator ligation; may be performed instead of or prior to open `37761`.
`36476`	Ligation, incompetent perforating vein(s), subfascial endoscopic; each additional limb	Used when endoscopic perforator ligation is performed on multiple limbs in the same operative session.
`37241`	Vascular embolization or occlusion, percutaneous, non-coronary, venous, any method, radiological supervision and interpretation	Endovenous or embolization techniques to occlude perforator or refluxing veins often used as an adjunct or alternative to open ligation.
`93971`	Duplex scan of extremity veins
Complete bilateral study	Pre- and/or post-procedure duplex ultrasound mapping and surveillance related to `37761`.
`36478`	Ligation, incompetent perforating vein(s), subfascial endoscopic; additional procedures	Adjunct or additional procedure coding when multiple subfascial endoscopic perforator ligations are performed concurrently.