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CPT 93985: Bilateral Upper Extremity Vascular Duplex for Hemodialysis Access

CPT code 93985 denotes a bilateral duplex ultrasound of arm arteries and veins performed to assess vascular supply and venous return before establishing hemodialysis access. This preoperative vascular mapping procedure matters nationally because it guides access site selection and helps reduce access failure and complication rates, influencing downstream costs and patient outcomes. Key payers in the national context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare.

Readers will find concise benchmarks and clinical context about when this imaging is used, typical sites of service, and payer coverage patterns. The publication outlines common documentation elements, coding context, and how the study fits into the care pathway for patients approaching hemodialysis. It also summarizes payer considerations and administrative touchpoints relevant to billing and authorization. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 93985 describes a duplex ultrasound examination of the arteries and veins in both upper extremities to evaluate vascular inflow and venous outflow prior to the creation of hemodialysis access. This service combines B-mode imaging with Doppler assessment to characterize vessel patency, diameter, and flow dynamics in the arms.

Service type: Diagnostic vascular duplex ultrasound for preoperative vascular mapping
Typical site of service: Outpatient vascular laboratory, hospital outpatient department, or ambulatory imaging center

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CPT 93985: Bilateral Upper Extremity Vascular Duplex for Hemodialysis Access

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Billing Code Overview

Service type: Diagnostic vascular duplex ultrasound for preoperative vascular mapping
Typical site of service: Outpatient vascular laboratory, hospital outpatient department, or ambulatory imaging center

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old with end-stage renal disease referred for preoperative vascular mapping prior to creation of an arteriovenous fistula or graft for hemodialysis access. The patient presents to the outpatient vascular laboratory or hospital radiology suite for a bilateral upper-extremity duplex ultrasound. The sonographer performs real-time gray-scale imaging, color Doppler, and spectral Doppler of the brachial, radial, ulnar, axillary, and subclavian arteries and accompanying veins to assess arterial inflow, vessel diameter, arterial wall condition, venous patency, and presence of central or peripheral venous stenosis or thrombosis. The study documents arterial velocities, vessel diameters, and the presence of arterial calcification or atherosclerotic disease that could affect inflow. Venous evaluation includes compressibility, diameter in both relaxed and tourniquet-enhanced states, and mapping of superficial and deep veins for adequacy as outflow conduits. Images and measurements are archived and a vascular surgeon or interventionalist reviews the findings to determine the optimal site for fistula/graft creation. Typical workflow steps: scheduling and pre-procedure history (including prior catheter or pacemaker history), focused physical exam documentation, sonographic acquisition by credentialed vascular sonographer, interpretation by physician (often vascular surgeon, interventional radiologist, or vascular medicine specialist), report generation, and communication of findings to the referring nephrologist and dialysis access surgeon.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician interpretation of the duplex exam provided separately from technical acquisition.
`TC`	Technical component	Use when billing only the technical portion (sonographer and equipment) of the study.
`52`	Reduced service	Use when the study is partially completed or limited and full protocol data cannot be obtained.
`59`	Distinct procedural service	Use to indicate a separate and distinct ultrasound service when multiple procedures are billed the same day and documentation supports distinct anatomic/clinical services.
`76`	Repeat procedure by same physician (Note: `76` is not in provided list)	Data not available in the input.
`78`	Unplanned return to the operating/procedure room by same physician following initial procedure (intra-procedural)	Rarely used; only applicable if study relates to a return to OR for complication management and billed in that context.
`80`	Assistant surgeon	Use when an assistant surgeon is separately reportable for a surgical procedure related to access creation (not typically appended to diagnostic ultrasound billing).
`62`	Two surgeons	Use in exceptional cases when two surgeons with different specialties perform separate primary portions of a related access procedure (not routine for diagnostic ultrasound alone).
`22`	Increased procedural services	Use when the ultrasound requires substantially greater work than typically required (extensive calcification, difficult access) and documentation supports unusual time/effort.
`50`	Bilateral procedure	Use when bilateral upper extremity arterial and venous duplex imaging is performed and payor requires a bilateral modifier instead of CPT's bilateral rules.

Taxonomy Code	Specialty	Notes
207P00000X	Vascular Surgery	Primary specialty that interprets and uses results for dialysis access planning.
207RA0000X	Radiology - Diagnostic	Interventional radiologists and diagnostic radiologists perform and interpret vascular duplex studies and access planning.
207V00000X	Nephrology	Ordering and clinical management specialty coordinating dialysis access timing; nephrologists commonly refer for mapping.
2084P0800X	Cardiovascular Disease	May be involved when arterial inflow disease is suspected or when central venous disease assessment informs access planning.
174400000X	Vascular Medicine	Specialists in vascular testing and duplex interpretation in some centers.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I12.0`	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	Hypertension is a common cause of ESRD; these patients require vascular mapping prior to dialysis access creation.
`N18.6`	End stage renal disease	Primary indication for creation of hemodialysis access and the main clinical reason for preoperative duplex mapping.
`T82.7XXA`	Infection and inflammatory reaction due to other vascular prosthetic devices, implants and grafts, initial encounter	Relevant when prior grafts or catheters have caused complications prompting evaluation of alternative access sites.
`I80.89`	Other phlebitis and thrombophlebitis of other sites	Upper‑extremity venous thrombosis can impact available veins for access and is assessed during mapping.
`I77.1`	Stricture of artery	Arterial stenosis or stricture can impair inflow and is assessed on arterial duplex before access planning.
`Z95.2`	Presence of prosthetic heart valve	History of intravascular devices or central lines (including pacemaker leads) can predispose to central venous stenosis; noted in preoperative evaluation.
`Z45.2`	Encounter for adjustment and management of vascular access device	Patients with prior or existing vascular access may undergo mapping for revision or new access creation.
`I87.2`	Venous insufficiency (chronic)	Chronic venous disease may affect vein suitability and is considered during venous mapping.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`93970`	Duplex scan of hemodialysis access (e.g., fistula, graft), real-time with spectral analysis, complete	Performed after access creation to evaluate maturation, flow, and detect stenosis or thrombosis; may follow `93985` mapping once access exists.
`93966`	Duplex scan of extremity veins including responses to compression and augmentation, unilateral or limited study	May be used for more limited venous evaluation or to document deep venous thrombosis if suspected in the upper extremity.
`93971`	Duplex scan of hemodialysis access, surveillance, unilateral or limited study	Used for periodic surveillance of a functioning access; complementary to preoperative mapping which is `93985`.
`93880`	Duplex scan of extracranial arteries; complete bilateral study	Different vascular territory but similar duplex methodology; listed for context of vascular laboratory capabilities.
`77046`	Fluoroscopic guidance for vascular access (placement, dilation, or insertion)	May be used when the imaging results from `93985` lead to percutaneous creation or intervention on access under imaging guidance.

CPT 93986: Upper Extremity Arterial and Venous Duplex for Pre-Dialysis Access

CPT-93990-DUPLEX-ULTRASOUND-HEMODIALYSIS-GRAFT-ASSESSMENT

CPT 93990: Duplex Ultrasound Assessment of Hemodialysis Graft

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 reporting only the physician interpretation of the duplex exam provided separately from technical acquisition.
`TC`	Technical component	Use when billing only the technical portion (sonographer and equipment) of the study.
`52`	Reduced service	Use when the study is partially completed or limited and full protocol data cannot be obtained.
`59`	Distinct procedural service	Use to indicate a separate and distinct ultrasound service when multiple procedures are billed the same day and documentation supports distinct anatomic/clinical services.
`76`	Repeat procedure by same physician (Note: `76` is not in provided list)	Data not available in the input.
`78`	Unplanned return to the operating/procedure room by same physician following initial procedure (intra-procedural)	Rarely used; only applicable if study relates to a return to OR for complication management and billed in that context.
`80`	Assistant surgeon	Use when an assistant surgeon is separately reportable for a surgical procedure related to access creation (not typically appended to diagnostic ultrasound billing).
`62`	Two surgeons	Use in exceptional cases when two surgeons with different specialties perform separate primary portions of a related access procedure (not routine for diagnostic ultrasound alone).
`22`	Increased procedural services	Use when the ultrasound requires substantially greater work than typically required (extensive calcification, difficult access) and documentation supports unusual time/effort.
`50`	Bilateral procedure	Use when bilateral upper extremity arterial and venous duplex imaging is performed and payor requires a bilateral modifier instead of CPT's bilateral rules.

Taxonomy Code	Specialty	Notes
207P00000X	Vascular Surgery	Primary specialty that interprets and uses results for dialysis access planning.
207RA0000X	Radiology - Diagnostic	Interventional radiologists and diagnostic radiologists perform and interpret vascular duplex studies and access planning.
207V00000X	Nephrology	Ordering and clinical management specialty coordinating dialysis access timing; nephrologists commonly refer for mapping.
2084P0800X	Cardiovascular Disease	May be involved when arterial inflow disease is suspected or when central venous disease assessment informs access planning.
174400000X	Vascular Medicine	Specialists in vascular testing and duplex interpretation in some centers.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I12.0`	Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease	Hypertension is a common cause of ESRD; these patients require vascular mapping prior to dialysis access creation.
`N18.6`	End stage renal disease	Primary indication for creation of hemodialysis access and the main clinical reason for preoperative duplex mapping.
`T82.7XXA`	Infection and inflammatory reaction due to other vascular prosthetic devices, implants and grafts, initial encounter	Relevant when prior grafts or catheters have caused complications prompting evaluation of alternative access sites.
`I80.89`	Other phlebitis and thrombophlebitis of other sites	Upper‑extremity venous thrombosis can impact available veins for access and is assessed during mapping.
`I77.1`	Stricture of artery	Arterial stenosis or stricture can impair inflow and is assessed on arterial duplex before access planning.
`Z95.2`	Presence of prosthetic heart valve	History of intravascular devices or central lines (including pacemaker leads) can predispose to central venous stenosis; noted in preoperative evaluation.
`Z45.2`	Encounter for adjustment and management of vascular access device	Patients with prior or existing vascular access may undergo mapping for revision or new access creation.
`I87.2`	Venous insufficiency (chronic)	Chronic venous disease may affect vein suitability and is considered during venous mapping.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`93970`	Duplex scan of hemodialysis access (e.g., fistula, graft), real-time with spectral analysis, complete	Performed after access creation to evaluate maturation, flow, and detect stenosis or thrombosis; may follow `93985` mapping once access exists.
`93966`	Duplex scan of extremity veins including responses to compression and augmentation, unilateral or limited study	May be used for more limited venous evaluation or to document deep venous thrombosis if suspected in the upper extremity.
`93971`	Duplex scan of hemodialysis access, surveillance, unilateral or limited study	Used for periodic surveillance of a functioning access; complementary to preoperative mapping which is `93985`.
`93880`	Duplex scan of extracranial arteries; complete bilateral study	Different vascular territory but similar duplex methodology; listed for context of vascular laboratory capabilities.
`77046`	Fluoroscopic guidance for vascular access (placement, dilation, or insertion)	May be used when the imaging results from `93985` lead to percutaneous creation or intervention on access under imaging guidance.

CPT 93986: Upper Extremity Arterial and Venous Duplex for Pre-Dialysis Access

CPT-93990-DUPLEX-ULTRASOUND-HEMODIALYSIS-GRAFT-ASSESSMENT

CPT 93990: Duplex Ultrasound Assessment of Hemodialysis Graft

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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CPT 93985: Bilateral Upper Extremity Vascular Duplex for Hemodialysis Access

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Billing Code Overview

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CPT 93985: Bilateral Upper Extremity Vascular Duplex for Hemodialysis Access

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References