C7514 Central Dialysis Segment — Reimbursement | OpenPayer

Summary & Overview

HCPCS C7514: Central Dialysis Segment Angioplasty with Stent Placement

HCPCS Level II code C7514 designates a complex interventional radiology procedure performed through a dialysis circuit that combines diagnostic angiography, fluoroscopic guidance, angioplasty of the central dialysis segment, and transcatheter placement of intravascular stents. The code is used when comprehensive imaging—from the arterial anastomosis through the full venous outflow including the superior or inferior vena cava—is required along with catheter placement and contrast injection. Nationally, this code captures high-acuity vascular access interventions that are integral to maintaining hemodialysis function and reducing access-related morbidity.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service represented by C7514, guidance on typical sites of service, and the types of procedural components bundled under this code. The publication also summarizes common billing considerations and associated practice patterns relevant to facilities and interventional radiology teams. Data not available in the input are explicitly noted where applicable. This resource is intended to clarify the clinical and billing scope of C7514 for national stakeholders in vascular access care and revenue integrity.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareC7514HCPCS Level IIinterventional radiologydialysis accessangioplastystent placementfluoroscopydiagnostic angiography

Billing Code Overview

HCPCS Level II code C7514 describes the introduction of needle(s) and/or catheter(s) into a dialysis circuit with diagnostic angiography of the dialysis circuit, including direct punctures and catheter placements, contrast injections, and comprehensive imaging from the arterial anastomosis and adjacent artery through the entire venous outflow to the inferior or superior vena cava. The procedure includes fluoroscopic guidance, angioplasty in the central dialysis segment, and transcatheter placement of intravascular stent(s) in the central dialysis segment, performed through the dialysis circuit. This service also encompasses required imaging, radiological supervision and interpretation, image documentation, and reporting.

Service Type: Interventional radiology procedure combining diagnostic angiography, angioplasty, and transcatheter stent placement of the central dialysis segment performed via the dialysis circuit
Typical Site of Service: Hospital outpatient department or ambulatory surgery center where advanced fluoroscopic and interventional radiology capabilities are available

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with end-stage renal disease (ESRD) on maintenance hemodialysis via a tunneled central venous dialysis catheter presents with progressive difficulty achieving adequate dialysis flow and elevated venous pressures during treatments. Duplex ultrasound suggests central venous outflow obstruction and the dialysis team documents recurrent catheter dysfunction despite thrombolytic attempts. The vascular interventional team schedules a procedure to access the dialysis circuit, perform diagnostic angiography of the arterial anastomosis through the entire venous outflow (including the superior or inferior vena cava as indicated), treat focal central dialysis segment stenosis with angioplasty, and deploy an intravascular stent if required.

The clinical workflow includes pre-procedure review of prior imaging and labs, informed consent, sterile field setup in an angiography suite, percutaneous introduction of needles/catheters through the dialysis circuit, fluoroscopically guided diagnostic angiography from arterial anastomosis through venous outflow, targeted balloon angioplasty of central dialysis segment lesions, transcatheter stent placement when residual stenosis or elastic recoil persists, completion angiography documenting technical success, radiological supervision and interpretation, image documentation, and post-procedure monitoring with dialysis unit communication for future access management.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased Procedural Services

HCPCS C1887: Guiding Catheter with Infusion/Perfusion Capability

HCPCS-C9101-OLICERIDINE-INJECTION-0-1-MG

HCPCS C9101: Injection, oliceridine, 0.1 mg

HCPCS-C2638-BRACHYTHERAPY-IODINE-125-STRANDED-SOURCE

HCPCS C2638: Brachytherapy Source, Stranded Iodine-125, Per Source

HCPCS-C1743-RESORBABLE-DRUG-ELUTING-ENDOVASCULAR-SCAFFOLD-IMPLANTABLE

HCPCS Level II C1743: Resorbable Drug-Eluting Endovascular Scaffold, Implantable

HCPCS-C8010-BILATERAL-CAROTID-EMBOLIC-PROTECTION-PLACEMENT

HCPCS C8010: Bilateral Common Carotid Embolic Protection Device Placement

HCPCS-C1747-DISPOSABLE-URINARY-ENDOSCOPE-IMAGING

HCPCS C1747: Disposable Urinary Tract Endoscope, Imaging/Illumination

HCPCS-C1725-TRANSLUMINAL-ANGIOPLASTY-CATHETER-NON-LASER

HCPCS C1725: Transluminal Angioplasty Catheter, Non-Laser

HCPCS-C1813-PENILE-INFLATABLE-PROSTHESIS

HCPCS C1813: Prosthesis, Penile, Inflatable

HCPCS-C2644-CESIUM-131-BRACHYTHERAPY-SOURCE-PER-MILLICURIE

HCPCS C2644: Cesium-131 Brachytherapy Source, Per Millicurie

HCPCS-C9772-TIBIAL-PERONEAL-REVASCULARIZATION-LITHOTRIPSY-ANGIOPLASTY

HCPCS C9772: Tibial/Peroneal Revascularization with Intravascular Lithotripsy

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Taxonomy Code	Specialty	Notes
`2080P0106X`	Vascular Surgery	Vascular surgeons commonly perform endovascular dialysis circuit interventions and stent placement.
`207RG0300X`	Interventional Radiology	Interventional radiologists frequently perform diagnostic angiography, angioplasty, and stent deployment in dialysis circuits.
`3336S0105X`	Nephrology (Interventional Nephrology)	Interventional nephrologists manage dialysis access interventions including angioplasty and stenting via dialysis circuits.
`2084P0800X`	Cardiovascular Disease (Interventional Cardiology)	Interventional cardiologists with peripheral endovascular expertise may perform central venous interventions.
`207K00000X`	Diagnostic Radiology	Diagnostic radiologists provide fluoroscopic imaging, supervision, and interpretation for these procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I82.401`	Acute embolism and thrombosis of unspecified deep veins of right lower extremity	Central venous thrombosis affecting dialysis outflow can cause catheter dysfunction and require angiography and intervention.
`I82.402`	Acute embolism and thrombosis of unspecified deep veins of left lower extremity	Thrombotic complications in venous outflow that compromise dialysis access may necessitate evaluation and treatment.
`I82.403`	Acute embolism and thrombosis of unspecified deep veins of bilateral lower extremities	Bilateral thrombosis scenarios impacting central venous return and dialysis catheter function.
`T82.4XXA`	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter	Infection related to vascular devices or grafts can complicate dialysis circuits and prompt imaging/intervention.
`N18.6`	End-stage renal disease	Underlying ESRD indicates ongoing hemodialysis and need for maintenance of dialysis access including central segment interventions.
`I89.0`	Lymphedema, not elsewhere classified	Chronic venous outflow obstruction leading to edema may be associated with central venous stenosis affecting dialysis access.
`I87.2`	Venous insufficiency (chronic) (peripheral)	Chronic venous disease can coexist with central venous stenosis contributing to access dysfunction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36215`	Selective catheter placement, arterial system; each first order thoracic, abdominal or limb branch vessel, within a vascular family, including all angiography when performed	May be used when selective arterial catheterization and angiography of an arterial anastomosis is performed as part of access evaluation prior to venous interventions.
`36147`	Introduction of catheter(s) for dialysis, central venous, includes imaging when performed	Related to dialysis catheter manipulation or replacement through which diagnostic angiography or interventions are performed.
`37236`	Transcatheter placement of intravascular stent(s), peripheral/cervical carotid, visceral, or other non-coronary, any method; initial vessel	Overlaps with transcatheter stent placement in central dialysis segment when payer requires CPT reporting for stent deployment.
`36901`	Endovascular catheterization, dialysis circuit; diagnostic, including imaging	Directly related diagnostic catheterization of the dialysis circuit; used in dialysis access interventions.
`35476`	Transluminal balloon angioplasty, dialysis circuit, central veins	Used when angioplasty of central dialysis segment stenosis is performed; typically reported for balloon angioplasty procedures.
`76000`	Fluoroscopy (separate procedure), imaging supervision and interpretation	Represents fluoroscopic imaging support; imaging is integral but may be reported when separate under payer rules.

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