CPT 61635 Intracranial Stent – Reimbursement

CPT code 61635 represents percutaneous endovascular treatment of intracranial arterial stenosis using balloon angioplasty with placement of a self‑expanding stent. This neurointerventional procedure addresses symptomatic or severe cerebrovascular narrowing that can lead to stroke and is performed by specialists in interventional neuroradiology, endovascular neurosurgery, or interventional neurology. Nationally, the code is important because it captures complex, resource‑intensive inpatient and outpatient procedures with implications for quality reporting, utilization management, and payer coverage policies.

Key payers included in national analyses are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, typical sites of service, and the payers commonly involved. The publication also highlights expected benchmarking topics such as utilization patterns, reimbursement considerations, and policy drivers relevant to hospitals and specialty practices. Data limitations are noted where input information is not provided. This summary is intended to inform coding, billing, and administrative audiences about the clinical scope and payer landscape associated with CPT code 61635.

Billing Code Overview

CPT code 61635 describes a transcatheter intracranial stent placement with balloon angioplasty, performed via percutaneous arterial access. In this procedure, a provider inserts a catheter—commonly through the femoral artery in the groin—and advances it through the vasculature to the site of a stenotic, plaque‑narrowed cerebral artery. A small balloon may be inflated at the narrowed segment to dilate the artery, followed by deployment of a self‑expanding mesh stent to scaffold the vessel and reduce restenosis.

Service Type: Endovascular neurointerventional procedure

Typical Site of Service: Hospital inpatient or hospital outpatient interventional radiology / endovascular suite, often accessed via the femoral artery in the groin.

Clinical Context

A 68-year-old male with symptomatic high-grade intracranial atherosclerotic stenosis of the internal carotid artery presents with recurrent transient ischemic attacks despite optimized medical therapy. Neurointerventional radiology evaluates the patient, confirming a focal 80% plaque-related stenosis on digital subtraction angiography. Under general anesthesia in an angiography suite, the interventionalist obtains percutaneous right femoral arterial access, advances a guide catheter into the cervical carotid artery, and navigates a microcatheter and guidewire into the intracranial segment. A balloon is inflated to dilate the stenotic segment, then a self-expanding intracranial stent is deployed across the lesion. Peri-procedural angiography confirms improved luminal diameter and distal flow. The patient is transferred to a neurocritical care unit for post-procedure neurological monitoring and dual antiplatelet therapy initiation.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When reporting only the physician’s interpretation component separate from technical facility services (rare for procedural codes where global billing is typical).
`52`	Reduced services

Taxonomy Code	Specialty	Notes
`207RH0000X`	Interventional Neuroradiology	Specialists who perform intracranial endovascular stenting and angioplasty.
`2084N0400X`	Vascular Neurology	Physicians involved in pre- and post-procedural stroke care and patient selection.
`208500000X`	Diagnostic Radiology	Radiologists with endovascular fellowship training who perform neurointerventional procedures.
`2086S0124X`	Neurosurgery	Neurosurgeons with endovascular training who may perform intracranial stenting.
`207K00000X`	Interventional Cardiology	Occasionally involved for peripheral access or complex endovascular support in hybrid cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I65.23`	Occlusion and stenosis of left carotid artery	Direct indication when symptomatic intracranial carotid stenosis requires angioplasty and stenting.
`I65.22`	Occlusion and stenosis of right carotid artery	Same relevance for right-sided intracranial carotid stenosis requiring endovascular treatment.
`I63.9`	Cerebral infarction, unspecified	Used when ischemic stroke is present and intracranial stenosis or embolic disease is treated.
`G45.9`	Transient ischemic attack, unspecified	Common presenting symptom leading to evaluation and possible stenting for symptomatic high-grade stenosis.
`I67.2`	Cerebral atherosclerosis	Underlying pathology often treated with intracranial angioplasty and stenting when focal and symptomatic.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61635`	Percutaneous transluminal angioplasty and intracranial stent placement for treatment of intracranial arterial stenosis	Primary procedure — describes arterial access, balloon angioplasty, and intracranial stent deployment.
`36215`	Selective catheterization of intracranial vessel, diagnostic	Performed prior to therapeutic intervention for vessel selection and angiographic roadmapping.
`36246`	Endovascular mechanical thrombectomy, intracranial, including all angiography and radiological supervision and interpretation	May be performed in the same session when thrombotic occlusion coexists or complication arises requiring clot retrieval.
`76937`	Ultrasound guidance for vascular access requiring image documentation	May be used for ultrasound-guided femoral arterial access prior to catheter introduction.
`93568`	Percutaneous transluminal angioplasty (PTA), coronary artery; single major coronary artery or branch — (Note: coronary example for cross-reference)	Not directly intracranial but analogous in technique; included here only if facility documents comparative billing in multidisciplinary settings.

OpenPayer

Summary & Overview

CPT 61635: Intracranial Balloon Angioplasty with Stent Placement