Summary & Overview

HCPCS C7532: Transluminal Balloon Angioplasty with Intravascular Ultrasound

HCPCS Level II code C7532 represents an endovascular transluminal balloon angioplasty of an initial noncoronary artery (open or percutaneous) performed with intravascular ultrasound and inclusive imaging and radiological supervision and interpretation. This code standardizes reporting when intravascular ultrasound is used as part of diagnostic evaluation and/or therapeutic intervention during an angioplasty procedure outside the coronary, intracranial, pulmonary, dialysis circuit, or lower-extremity occlusive settings. Nationally, accurate coding of procedures with intravascular imaging matters for clinical documentation, resource tracking, and payer adjudication, given the specialized equipment and procedural complexity.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage considerations, common modifiers used with interventional procedures, and clinical context for when this code applies. The publication provides benchmarks and policy-relevant notes to clarify coding scope, typical sites of service, and the procedural elements bundled into the code. Data not available in the input are explicitly noted where applicable; the content focuses on helping coding, billing, and clinical teams understand the scope and intended use of C7532 in a national context.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC7532HCPCS Level IIangioplastyintravascular ultrasoundinterventional radiologyendovascularambulatory surgical centerhospital outpatientprocedure coding

Billing Code Overview

HCPCS Level II code C7532 describes a transluminal balloon angioplasty procedure for an initial noncoronary artery (excluding lower extremity arteries for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit). The code includes the angioplasty (open or percutaneous) of the initial artery and encompasses all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, with intravascular ultrasound performed during diagnostic evaluation and/or therapeutic intervention.

Service Type: Endovascular transluminal balloon angioplasty with intravascular ultrasound (initial noncoronary vessel)

Typical Site of Service: Hospital outpatient department or ambulatory surgical center where interventional radiology or vascular procedures are performed

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with progressive, lifestyle-limiting claudication presents after noninvasive vascular testing that demonstrates a focal, moderately severe stenosis of a superficial femoral artery segment not involving the coronary, intracranial, pulmonary, dialysis circuit, or lower extremity occlusive disease listed exceptions. After discussion of risks and benefits, the patient is scheduled for a transluminal balloon angioplasty of the affected artery. The procedure is performed in an interventional radiology or vascular surgery suite under conscious sedation. Vascular access is obtained percutaneously, diagnostic angiography confirms the target lesion, and a balloon angioplasty is performed in the initial treated artery. Intravascular ultrasound (IVUS) is used during diagnostic evaluation and to guide therapeutic intervention. All imaging and radiological supervision and interpretation necessary to perform the angioplasty and IVUS are provided during the same session. Post-procedure, the patient is observed for access site hemostasis and limb perfusion and discharged the same day or admitted for monitoring if clinically indicated.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When work required is substantially greater than typical for the angioplasty (e.g., complex anatomy, prolonged procedure).
`23`	Unusual anesthesia	When general anesthesia is medically necessary for an otherwise non‑anesthetized procedure.
`50`	Bilateral procedure	When identical procedure performed on contralateral artery during same operative session.
`51`	Multiple procedures	When multiple distinct procedures are performed in the same session and payer requires reporting.
`52`	Reduced services	When the angioplasty is partially reduced or incomplete but still performed.
`53`	Discontinued procedure	When the angioplasty is started but terminated due to patient instability or unexpected condition.
`62`	Two surgeons	When two surgeons with different NPI numbers perform distinct surgical portions of the case.
`66`	Team surgical approach	When a documented surgical team approach is used requiring separate billing considerations.
`78`	Unplanned return to the operating room	When the patient returns to the OR intra‑ or postoperatively for a related procedure during the global period.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for surgical assistance	When an advanced practice clinician provides assisted surgical services during the procedure.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	When the reporting physician medically directs multiple concurrent anesthesia cases.
`QX`	CRNA service furnished under a physician’s supervision	When a certified registered nurse anesthetist provides anesthesia under physician supervision.
`QY`	Medical direction of one CRNA by an anesthesiologist	When an anesthesiologist medically directs one CRNA for the case.
`SG`	Monitored anesthesia care (MAC) for deep sedation/analgesia	When MAC is billed for deep sedation during the procedure.

Taxonomy Code	Specialty	Notes
`207P00000X`	Vascular Surgery	Common specialty performing peripheral arterial angioplasty.
`207K00000X`	Interventional Cardiology	Performs peripheral interventions in some centers; IVUS expertise.
`2086S0102X`	Interventional Radiology	Frequently performs transluminal angioplasty with imaging guidance.
`363L00000X`	Diagnostic Radiology	Provides radiological supervision and interpretation in vascular procedures.
`2080P0208X`	General Surgery	May perform peripheral endovascular interventions depending on practice.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.219`	Atherosclerosis of native arteries of the extremities, unspecified, left leg	Peripheral arterial atherosclerotic stenosis is a common indication for transluminal balloon angioplasty.
`I70.213`	Atherosclerosis of native arteries of the extremities with intermittent claudication, right leg	Claudication due to peripheral arterial disease often prompts angiographic evaluation and angioplasty.
`I70.228`	Atherosclerosis of native arteries of the extremities with rest pain, bilateral legs	Ischemic rest pain indicates more severe peripheral arterial disease warranting intervention.
`I70.229`	Atherosclerosis of native arteries of the extremities with ulceration, unspecified leg	Tissue loss or ulceration from ischemia may require revascularization with angioplasty.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute or subacute embolic/thrombotic lesions may be treated with endovascular techniques including angioplasty.
`I77.1`	Stricture of artery	Focal arterial strictures are directly amenable to balloon angioplasty.
`G45.9`	Transient cerebral ischemic attack, unspecified (Included only if intracranial procedures were relevant)	Not typically used for this code; listed here for completeness when noncoronary, nonintracranial IVUS is considered.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37220`	Angioplasty, percutaneous, initial vessel (noncoronary), radiological supervision and interpretation	Often used interchangeably for percutaneous transluminal angioplasty of a noncoronary artery; may be billed when IVUS is not separately reported.
`37221`	Angioplasty, percutaneous, each additional vessel (noncoronary)	Used when angioplasty is performed in an additional artery during the same session.
`37252`	Transcatheter placement of intravascular stent(s), open or percutaneous, non-coronary, initial vessel	Performed when angioplasty results require stent placement during the same procedure.
`37253`	Transcatheter placement of intravascular stent(s), each additional vessel	Used for stent placement in additional arteries in the same session.
`93662`	Intracoronary ultrasound during coronary diagnostic study or therapeutic intervention (Note: coronary-specific)	IVUS CPTs for noncoronary vessels do not map directly to this code; IVUS imaging time and interpretation are integral to angioplasty reporting and may be separately reportable depending on payer policy.
`76937`	Ultrasound guidance for vascular access	Used when ultrasound is used for arterial access guidance prior to angioplasty.