Summary & Overview
CPT 93925: Bilateral Lower-Extremity Duplex Ultrasound
CPT code 93925 represents a bilateral duplex ultrasound examination of the lower extremity arteries or bypass grafts. This noninvasive vascular imaging procedure combines grayscale imaging and Doppler flow assessment to evaluate blood flow patterns and identify arterial stenosis, occlusion, or graft dysfunction. Nationally, this code is relevant for vascular specialists, radiology and vascular laboratory services, and facilities managing peripheral arterial disease and post-operative graft surveillance.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and typical sites of service, payer coverage patterns and common modifier usage, and operational benchmarks relevant to billing and documentation for noninvasive arterial studies. The publication also summarizes coding nuances, common billing pitfalls, and where to seek appropriate documentation to support medical necessity.
The content is intended for national audiences involved in clinical operations, revenue cycle management, and payer contracting. It provides context on clinical utility, expected service settings, and the administrative elements that influence accurate claim submission for CPT code 93925. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 93925 describes a duplex ultrasound scan of the lower extremity arteries or bypass grafts performed bilaterally. The procedure is a noninvasive arterial diagnostic study that combines real-time B-mode imaging with Doppler flow assessment to evaluate blood flow velocity and detect stenosis or occlusion in the lower extremity arterial system or in surgically created bypass grafts.
Service Type: Noninvasive vascular diagnostic imaging
Typical Site of Service: Hospital outpatient departments, vascular laboratories, and outpatient imaging centers
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a history of peripheral arterial disease, hypertension, and hyperlipidemia presents with progressive left calf claudication after walking two blocks. The vascular surgeon orders a bilateral lower extremity arterial duplex (93925) to evaluate arterial inflow, locate stenosis or occlusion, and assess bypass graft patency if present. The clinical workflow includes: referral from the vascular clinic, scheduling the noninvasive vascular laboratory appointment, pre-scan assessment (review of medications, prior imaging, and pulse exam), performance of a bilateral duplex ultrasound by a vascular sonographer with real-time interpretation by a vascular laboratory physician or credentialed vascular surgeon, generation of a documented report with Doppler velocities and waveform analysis, and transmission of results to the ordering provider for management decisions (medical therapy, angiography, or surgical intervention). Typical site of service is an outpatient vascular laboratory, hospital outpatient department, or ambulatory surgery center when performed as a diagnostic exam prior to intervention.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation of the duplex and the technical component is billed separately. |
TC | Technical component | Use when billing only the technical component (equipment and sonographer) and the physician interpretation is billed separately. |
59 | Distinct procedural service | Use when another distinct, separately reportable vascular ultrasound or procedure is performed the same day and documentation supports separate services. |
76 | Repeat procedure by same physician | Use when the same duplex study is repeated on the same patient by the same physician on the same day. |
77 | Repeat procedure by another physician | Use when the duplex is repeated by a different physician on the same day. |
52 | Reduced services | Use when the study is partially reduced or incomplete and documentation explains the reason. |
53 | Discontinued procedure | Use when the duplex exam is started but discontinued for patient safety or intolerance and documented. |
RT | Right side | Use when reporting laterality specifically for unilateral services when applicable; for bilateral 93925 this is less common but may apply if separate side reporting is required. |
LT | Left side | Use when reporting laterality specifically for unilateral services; see note under RT. |
26 | Professional component | (listed once above as standard) — included here for clarity when splitting components. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 2080S0002X | Vascular Surgery | Surgeons who commonly order and interpret arterial duplex studies for PAD and bypass graft evaluation. |
| 207R00000X | Interventional Cardiology | Interventionalists who evaluate peripheral arterial disease as part of endovascular planning. |
| 207K00000X | Cardiovascular Disease (Non-invasive) | Physicians who manage vascular risk factors and order diagnostic vascular ultrasound. |
| 246Z00000X | Diagnostic Vascular Sonography | Sonography professionals who perform the technical component of duplex arterial studies. |
| 261QA2300X | Radiology – Diagnostic | Diagnostic radiologists who may interpret vascular ultrasound studies in hospital settings. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I70.2 | Atherosclerosis of native arteries of the extremities | Primary cause of peripheral arterial disease prompting 93925 duplex evaluation for stenosis or occlusion. |
I73.9 | Peripheral vascular disease, unspecified | Common presenting diagnosis when patients have limb ischemia or claudication requiring arterial duplex. |
I70.219 | Atherosclerosis of native arteries of extremities, bilateral legs | Specifies bilateral disease consistent with a bilateral duplex study. |
I74.3 | Embolism and thrombosis of arteries of lower extremities | Acute arterial occlusion assessment may include duplex to identify flow compromise. |
Z95.2 | Presence of prosthetic heart valve | While not directly related, presence of prosthetics or grafts (see Z98.890) influences interpretation and may prompt graft surveillance. |
Z98.890 | Other specified postprocedural states | Used to indicate prior arterial bypass grafts; 93925 assesses graft patency. |
R02 | Gangrene, not elsewhere classified | Severe ischemia requiring arterial imaging as part of limb salvage evaluation. |
M79.601 | Pain in right leg | Symptom code that may support medical necessity when correlated with vascular findings. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
93922 | Noninvasive physiologic studies of upper or lower extremity arteries, single level; segmental pressures | Often performed adjunctively to 93925 to document segmental pressures and ankle-brachial indices in peripheral arterial disease assessment. |
93923 | Noninvasive physiologic studies of upper or lower extremity arteries, multiple levels; segmental pressures | Performed when multi-level arterial disease is suspected and more extensive physiologic assessment is required alongside duplex imaging. |
93930 | Duplex scan of arterial inflow and outflow legs (unilateral) | Used when a unilateral comprehensive duplex is performed instead of bilateral; may be selected if only one extremity requires study. |
93880 | Duplex scan of extracranial arteries; complete bilateral study | Used in cerebrovascular vascular evaluation workflows and occasionally performed in parallel when systemic atherosclerotic disease is evaluated. |
93971 | Duplex scan of transplanted organ (e.g., renal) arterial/venous | Different organ system duplex studies that may be performed in vascular labs; listed here as related duplex modality but not common for lower extremity arterial workups. |