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CPT 38200: Splenoportography of the Portal Venous System

CPT code 38200 represents splenoportography, a diagnostic radiologic procedure in which a catheter is placed in the splenic vein and contrast is injected to visualize the portal venous system. Nationally, this code is used for evaluation of portal vein patency, assessment of portal hypertension, and characterization of portal-system vascular anatomy prior to or as part of interventional therapy. The procedure is typically performed in hospital radiology or interventional radiology settings using fluoroscopic guidance.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, common billing considerations, and the typical sites of service. The publication summarizes benchmarks where available, highlights relevant policy and coverage considerations at a national level, and explains how the code fits into diagnostic and interventional care pathways. Data not available in the input are noted where applicable, including specific payer reimbursement rates, associated taxonomies, and ICD‑10 diagnosis pairings.

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Billing Code Overview

CPT code 38200 describes a splenoportography procedure in which a provider inserts a catheter into the splenic vein, injects contrast material, and acquires X‑ray images to evaluate the portal venous system. This imaging study is performed to assess portal vein patency, portal hypertension, and related vascular anatomy.

Service type: Diagnostic vascular radiologic procedure involving direct venous catheterization and contrast injection
Typical site of service: Hospital radiology suite or interventional radiology laboratory, often performed with fluoroscopic guidance

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CPT 38200: Splenoportography of the Portal Venous System

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Billing Code Overview

Service type: Diagnostic vascular radiologic procedure involving direct venous catheterization and contrast injection
Typical site of service: Hospital radiology suite or interventional radiology laboratory, often performed with fluoroscopic guidance

Clinical & Coding Specifications

Clinical Context

A typical patient is a 55-year-old with known cirrhosis and progressive ascites with new-onset portal hypertension signs (refractory variceal bleeding or suspected portal vein thrombosis). The hepatology team requests diagnostic splenoportography to visualize portal venous anatomy and assess portal vein patency and pressure gradients prior to planning portosystemic shunt, transjugular intrahepatic portosystemic shunt (TIPS), or surgical intervention. The patient arrives to the interventional radiology suite fasting, with IV access and coagulation studies reviewed. Conscious sedation or monitored anesthesia care is provided. Under ultrasound guidance, the interventional radiologist accesses the splenic vein via a percutaneous transsplenic or transhepatic approach, advances a catheter into the splenic vein, injects iodinated contrast, and acquires fluoroscopic images to evaluate portal venous flow, variceal supply, and thrombosis. Post-procedure monitoring includes analgesia, hemostasis observation, and instructions about activity and signs of bleeding or infection. Documentation includes indication, informed consent, access site, catheter type, contrast volume, fluoroscopy time, findings, and any complications.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing physician interpretation separate from facility technical component.
`50`	Bilateral procedure	Not typically applicable but used if bilateral anatomic consideration applies in rare coding contexts.
`51`	Multiple procedures	Append when other unrelated procedures are billed on the same day.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as reported.
`53`	Discontinued procedure	Use when procedure is terminated due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons share responsibility due to complexity.
`63`	Procedure performed on infants (<4 kg)	Rare; use when patient meets weight criteria and code definitions.
`78`	Return to the operating room for a related procedure during the postoperative period	Use if a related return trip to OR/intervention is required for a complication.
`80`	Assistant surgeon	Use when an assistant surgeon participates and payer requires modifier for payment.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services as primary surgeon	Use when an advanced practice clinician performs the procedure as primary operator per payer rules.
`QX`	Assistant surgeon certification of documentation on file	Use when assistant surgeon requirements for documentation are met.
`QY`	Medical direction of two, three, or four concurrent anesthesia procedures	Use when physician directs multiple concurrent anesthesia services during this procedure.
`22`	Increased procedural services	Use when work required is substantially greater than typical (document rationale)
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary but not normally required for this procedure

Taxonomy Code	Specialty	Notes
`207RC0000X`	Interventional Radiology	Primary specialty performing splenoportography and portal venous interventions.
`2080P0207X`	Vascular Surgery	May perform portal venous surgical planning and related access procedures.
`207L00000X`	Diagnostic Radiology	Performs diagnostic imaging and interpretation when interventional radiology not involved.
`207LA0401X`	Nephrology (Interventional)	Occasionally involved for vascular access planning in complex patients.
`208000000X`	General Surgery	Involved when surgical consultation or open procedures are planned related to portal hypertension.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I85.01`	Esophageal varices with bleeding	Portal hypertension complications; splenoportography evaluates variceal supply and portal anatomy.
`I82.409`	Acute embolism and thrombosis of unspecified deep veins of lower extremity, unspecified	Thrombosis elsewhere can prompt evaluation of portal vein thrombosis risk; included as a related vascular thrombosis code when assessing portal patency.
`K76.6`	Portal hypertension	Primary indication for splenoportography to define portal venous anatomy and patency.
`I82.890`	Other specified venous embolism and thrombosis	Includes portal vein thrombosis codes; splenoportography assesses portal vein thrombus and collateral circulation.
`K72.90`	Hepatic failure, unspecified, without coma	Chronic liver disease with decompensation often prompts portal venous evaluation.
`R18.8`	Other ascites	Symptom-driven indication to evaluate portal hypertension contributing to ascites.
`I81`	Portal vein thrombosis	Direct indication—splenoportography visualizes portal vein occlusion and collateral formation.
`C22.0`	Liver cell carcinoma	Malignancy can invade portal venous system; imaging of portal circulation may be required.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36200`	Selective catheter placement, arterial system; initial third order or more selective catheter placement, radiological supervision and interpretation	May be performed during portal venous evaluation if arterial-portal mapping or arterial embolization is required.
`36010`	Introduction of needle or intracatheter, vein; for diagnostic purposes, initial venous access of central or peripheral veins	May be used for venous access lines required during procedure.
`75774`	Transcatheter placement, portal vein measurement/pressure; portal venography, percutaneous, with imaging	Directly related imaging of portal venous system; may be used alongside or instead of splenoportography in some workflows.
`49420`	Peritoneal drainage (e.g., paracentesis); therapeutic large volume	Performed in patients with ascites being evaluated for portal hypertension prior to or after splenoportography.
`76937`	Ultrasound guidance for vascular access requiring radiologist interpretation and report	Used for ultrasound-guided splenic or portal venous access during the procedure.

Frequently Asked Questions

References

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.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.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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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing physician interpretation separate from facility technical component.
`50`	Bilateral procedure	Not typically applicable but used if bilateral anatomic consideration applies in rare coding contexts.
`51`	Multiple procedures	Append when other unrelated procedures are billed on the same day.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as reported.
`53`	Discontinued procedure	Use when procedure is terminated due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons share responsibility due to complexity.
`63`	Procedure performed on infants (<4 kg)	Rare; use when patient meets weight criteria and code definitions.
`78`	Return to the operating room for a related procedure during the postoperative period	Use if a related return trip to OR/intervention is required for a complication.
`80`	Assistant surgeon	Use when an assistant surgeon participates and payer requires modifier for payment.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services as primary surgeon	Use when an advanced practice clinician performs the procedure as primary operator per payer rules.
`QX`	Assistant surgeon certification of documentation on file	Use when assistant surgeon requirements for documentation are met.
`QY`	Medical direction of two, three, or four concurrent anesthesia procedures	Use when physician directs multiple concurrent anesthesia services during this procedure.
`22`	Increased procedural services	Use when work required is substantially greater than typical (document rationale)
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary but not normally required for this procedure

Taxonomy Code	Specialty	Notes
`207RC0000X`	Interventional Radiology	Primary specialty performing splenoportography and portal venous interventions.
`2080P0207X`	Vascular Surgery	May perform portal venous surgical planning and related access procedures.
`207L00000X`	Diagnostic Radiology	Performs diagnostic imaging and interpretation when interventional radiology not involved.
`207LA0401X`	Nephrology (Interventional)	Occasionally involved for vascular access planning in complex patients.
`208000000X`	General Surgery	Involved when surgical consultation or open procedures are planned related to portal hypertension.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I85.01`	Esophageal varices with bleeding	Portal hypertension complications; splenoportography evaluates variceal supply and portal anatomy.
`I82.409`	Acute embolism and thrombosis of unspecified deep veins of lower extremity, unspecified	Thrombosis elsewhere can prompt evaluation of portal vein thrombosis risk; included as a related vascular thrombosis code when assessing portal patency.
`K76.6`	Portal hypertension	Primary indication for splenoportography to define portal venous anatomy and patency.
`I82.890`	Other specified venous embolism and thrombosis	Includes portal vein thrombosis codes; splenoportography assesses portal vein thrombus and collateral circulation.
`K72.90`	Hepatic failure, unspecified, without coma	Chronic liver disease with decompensation often prompts portal venous evaluation.
`R18.8`	Other ascites	Symptom-driven indication to evaluate portal hypertension contributing to ascites.
`I81`	Portal vein thrombosis	Direct indication—splenoportography visualizes portal vein occlusion and collateral formation.
`C22.0`	Liver cell carcinoma	Malignancy can invade portal venous system; imaging of portal circulation may be required.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36200`	Selective catheter placement, arterial system; initial third order or more selective catheter placement, radiological supervision and interpretation	May be performed during portal venous evaluation if arterial-portal mapping or arterial embolization is required.
`36010`	Introduction of needle or intracatheter, vein; for diagnostic purposes, initial venous access of central or peripheral veins	May be used for venous access lines required during procedure.
`75774`	Transcatheter placement, portal vein measurement/pressure; portal venography, percutaneous, with imaging	Directly related imaging of portal venous system; may be used alongside or instead of splenoportography in some workflows.
`49420`	Peritoneal drainage (e.g., paracentesis); therapeutic large volume	Performed in patients with ascites being evaluated for portal hypertension prior to or after splenoportography.
`76937`	Ultrasound guidance for vascular access requiring radiologist interpretation and report	Used for ultrasound-guided splenic or portal venous access during the procedure.

Frequently Asked Questions

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

CPT 38200: Splenoportography of the Portal Venous System

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Billing Code Overview

CPT 38200: Splenoportography of the Portal Venous System

Sign up for cpt 38200 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

What does CPT 38200 (splenoportography) cover and when is it typically performed?

What diagnoses or clinical situations commonly justify using CPT 38200?

Which billing modifiers are relevant to CPT 38200 and when might they apply?

Which specialties and taxonomy codes are commonly involved in performing or interpreting splenoportography?

What other CPT codes are commonly associated with or used alongside CPT 38200?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

What does CPT 38200 (splenoportography) cover and when is it typically performed?

What diagnoses or clinical situations commonly justify using CPT 38200?

Which billing modifiers are relevant to CPT 38200 and when might they apply?

Which specialties and taxonomy codes are commonly involved in performing or interpreting splenoportography?

What other CPT codes are commonly associated with or used alongside CPT 38200?

References