CPT 93926 Duplex Ultrasound Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 93926: Duplex Ultrasound, Lower Extremity Artery or Bypass (One Side)

CPT code 93926 denotes a duplex ultrasound of the lower extremity arteries or bypass grafts performed on one side. This noninvasive vascular imaging procedure evaluates arterial blood flow and identifies blockages or stenosis, supporting diagnosis and management of peripheral arterial disease and monitoring of graft patency. Nationally, the code is important for vascular labs, hospital outpatient services, and ambulatory imaging centers because it guides clinical decision-making without exposing patients to ionizing radiation or contrast agents.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context, common service locations, and payer scope. The publication summarizes typical usage and documentation considerations, provides benchmark-oriented coverage notes for the listed payers, and highlights where policy updates or coding guidance may affect billing and reimbursement. The content is intended to help administrators and billing staff understand the clinical role of 93926, expected sites of service, and the payers commonly involved in coverage and payment decisions. Data not available in the input for associated taxonomies, specific ICD-10 pairings, or related CPT codes is noted as missing in the respective sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare93926CPTvascular-imagingduplex-ultrasoundperipheral-arterial-diseasenoninvasive-diagnosticslower-extremitygraft-surveillance

Billing Code Overview

CPT code 93926 describes a duplex ultrasound scan of lower extremity arteries or bypass grafts performed on one side. The procedure is a noninvasive arterial diagnostic test that combines real-time ultrasound imaging with Doppler flow assessment to evaluate blood flow velocity and detect arterial obstruction or stenosis in a single lower extremity or its bypass graft.

Service Type: Noninvasive vascular diagnostic imaging

Typical Site of Service: Vascular laboratory, hospital outpatient imaging center, or ambulatory surgical/diagnostic center

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of peripheral arterial disease, smoking, hypertension, and type 2 diabetes presents with progressive left calf claudication and decreased ankle-brachial index. The vascular medicine team orders a diagnostic arterial duplex ultrasound of the left lower extremity to assess for arterial stenosis or occlusion prior to planning intervention. The patient arrives to the outpatient vascular laboratory where an ultrasound technologist performs a complete duplex scan of the left lower extremity arterial circulation, including Doppler spectral waveforms, peak systolic velocity measurements, and imaging of the common femoral, superficial femoral, popliteal, tibial and pedal arteries. A vascular medicine physician or vascular surgeon reviews images and interprets the study, documents findings in the medical record, and provides recommendations for medical management or referral for angiography/revascularization if significant disease is detected. Typical site of service is the outpatient vascular laboratory or hospital outpatient imaging department; this single-sided arterial duplex is billed using 93926 for one lower extremity arterial study.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the physician interpretation/report separate from technical component.

CPT 93925: Bilateral Lower-Extremity Duplex Ultrasound

CPT-93924-LEG-ARTERIAL-EXERCISE-BLOOD-FLOW-ASSESSMENT

CPT 93924: Exercise-Based Leg Arterial Blood Flow Assessment

93923-COMPLETE-BILATERAL-NONINVASIVE-PHYSIOLOGIC-STUDIES-OF-UPPER

CPT 93923: Complete Bilateral Noninvasive Extremity Arterial Physiologic Study

CPT-93930-UPPER-EXTREMITY-DUPLEX-ULTRASOUND-BILATERAL

CPT 93930: Duplex Ultrasound of Upper Extremity Arteries, Bilateral

CPT-93931-UPPER-EXTREMITY-ARTERIAL-DUPLEX-UNILATERAL

CPT 93931: Upper Extremity Arterial Duplex, Unilateral

93922-NONINVASIVE-PHYSIOLOGIC-STUDIES-OF-UPPER-OR-LOWER-EXTREMITY

93922 – Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral

Taxonomy Code	Specialty	Notes
`2080S0004X`	Vascular Surgery	Common interpreting and procedural specialty for lower extremity arterial duplex and subsequent interventions.
`207RG0300X`	Interventional Cardiology	May interpret arterial studies and perform endovascular procedures when peripheral interventions are needed.
`207RH0000X`	Radiology (Diagnostic Radiology)	Often interprets duplex studies in hospital imaging departments.
`207L00000X`	Family Medicine	May order and review results in primary care settings for initial evaluation and referral.
`207K00000X`	Internal Medicine	Manages vascular risk factors and coordinates diagnostic testing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of the extremities with intermittent claudication, left leg	Common indication for lower extremity arterial duplex to evaluate arterial stenosis causing claudication.
`I70.91`	Unspecified atherosclerosis, peripheral artery, unspecified site	Used when peripheral atherosclerotic disease is present and duplex is ordered to localize disease.
`I73.9`	Peripheral vascular disease, unspecified	Broad diagnosis prompting arterial imaging to assess severity and distribution.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute ischemia evaluation may include duplex to identify occlusion and flow characteristics.
`Z95.2`	Presence of prosthetic heart valve — placeholder	Data not in input — omitted.
`E11.51`	Type 2 diabetes mellitus with peripheral angiopathy without gangrene	Diabetes-associated peripheral vascular disease commonly evaluated with arterial duplex.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`93922`	Limited bilateral or unilateral noninvasive physiologic studies of upper or lower extremity arteries, single level	May be performed when only limited segmental physiologic testing is required instead of a complete duplex.
`93925`	Duplex scan of lower extremity arteries or bypass grafts, bilateral or unilateral, complete study	Used when a complete study of both extremities or the applicable comprehensive bilateral code is required; relates as a broader or bilateral alternative to `93926`.
`93930`	Duplex scan of arterial inflow and outflow with imaging for graft surveillance	Performed for graft surveillance and inflow/outflow assessment; complements `93926` when bypass grafts are present.
`93880`	Duplex scan of extracranial arteries; complete bilateral study	Often performed in the same vascular lab for patients requiring cerebrovascular assessment in addition to peripheral arterial evaluation.
`77046`	Vascular imaging guidance for therapeutic infusion/puncture — procedure code example	May be used for image guidance during subsequent endovascular interventions prompted by duplex findings.

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