C7535 Femoral–Popliteal Stent Reimbursement | OpenPayer

Summary & Overview

HCPCS C7535: Femoral–Popliteal Revascularization with Stent and IVUS

HCPCS Level II code C7535 represents unilateral revascularization of the femoral–popliteal artery with transluminal stent placement, including angioplasty when performed and intravascular ultrasound during diagnostic evaluation or intervention. This procedure-level code captures a complex peripheral vascular intervention that combines endovascular techniques, imaging, and radiological supervision.

The code matters nationally because peripheral arterial disease and limb-threatening ischemia are significant drivers of vascular intervention volume and resource utilization. Proper coding ensures accurate aggregation of utilization, supports quality measurement, and affects coverage and payment processes across major payers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical and procedural context for C7535, typical sites of service, and the core elements bundled into the code (stent placement, angioplasty when performed, and intravascular ultrasound). The publication also outlines benchmarking considerations, common billing modifiers used with complex vascular procedures, and policy or coverage themes that commonly affect peripheral endovascular services. Data-specific benchmarks, associated taxonomies, ICD-10 diagnoses, and related procedure codes are noted as available or not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC7535HCPCS Level IIfemoral popliteal stentperipheral vascular interventionendovascular revascularizationintravascular ultrasoundangioplastyinterventional radiology

Billing Code Overview

HCPCS Level II code C7535 describes revascularization of the femoral–popliteal artery (unilateral) with transluminal stent placement(s). The procedure includes angioplasty within the same vessel when performed and the use of intravascular ultrasound during the initial diagnostic evaluation and/or therapeutic intervention. The description indicates comprehensive radiological supervision and interpretation are included.

Service type: Endovascular or percutaneous vascular revascularization with stent placement, including intravascular imaging when performed.

Typical site of service: Hospital outpatient department, ambulatory surgical center, or interventional radiology/cardiovascular catheterization laboratory.

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with a history of peripheral arterial disease and lifestyle-limiting claudication presents with progressive right calf pain after walking short distances and nonhealing ischemic ulceration over the right lateral foot. Noninvasive vascular testing demonstrates an ankle-brachial index of 0.6 on the right and segmental pressures suggest femoropopliteal occlusive disease. Diagnostic angiography confirms a significant stenosis/occlusion of the right superficial femoral and proximal popliteal arteries. The interventional vascular team proceeds with endovascular revascularization of the right femoral-popliteal segment, performing transluminal angioplasty with deployment of one or more stents and intravascular ultrasound performed during the diagnostic evaluation and to guide stent sizing and placement.

Typical workflow:

Pre-procedure evaluation in the vascular clinic and consent, including review of comorbidities and antiplatelet management.
Admission to an outpatient procedural suite or inpatient angiography suite depending on clinical status.
Procedural angiography of the lower extremity arterial tree, followed by intravascular ultrasound (IVUS) of the target noncoronary vessel for lesion characterization.
Percutaneous transluminal angioplasty of the femoral-popliteal lesion(s) with placement of endovascular stent(s) as indicated.
Post-deployment angiography and IVUS confirmation of stent apposition and flow.
Post-procedure monitoring with access site observation, vascular checks, and discharge planning or inpatient observation as clinically indicated.

HCPCS C7532: Transluminal Balloon Angioplasty with Intravascular Ultrasound

HCPCS-C7514-CENTRAL-DIALYSIS-SEGMENT-ANGIOPLASTY-STENT-PLACEMENT

HCPCS C7514: Central Dialysis Segment Angioplasty with Stent Placement

HCPCS-C9058-PEGFILGRASTIM-BIOSIMILAR-INJECTION-0-5-MG

HCPCS Level II C9058: Pegfilgrastim-bmez (Ziextenzo) 0.5 mg Injection

HCPCS-C9737-ESOPHAGEAL-SPHINCTER-AUGMENTATION-LAPAROSCOPY

HCPCS C9737: Laparoscopic Esophageal Sphincter Augmentation

HCPCS-C5278-LOW-COST-SKIN-SUBSTITUTE-GRAFT-ADDITIONAL-WOUND-AREA

HCPCS Level II C5278: Low Cost Skin Substitute Graft, Additional Wound Area

HCPCS-C9457-SULFUR-HEXAFLUORIDE-CONTRAST-INJECTION

HCPCS C9457: Sulfur Hexafluoride Lipid Microsphere Injection, per mL

HCPCS-C1823-IMPLANTABLE-NON-RECHARGEABLE-NEUROSTIMULATOR-TRANSVENOUS

HCPCS C1823: Implantable Non-Rechargeable Neurostimulator with Transvenous Leads

HCPCS-C2614-PERCUTANEOUS-LUMBAR-DISCECTOMY-PROBE

HCPCS C2614: Probe, Percutaneous Lumbar Discectomy

HCPCS-C1716-BRACHYTHERAPY-GOLD-198-SOURCE

HCPCS Level II C1716: Brachytherapy Source, Gold-198

HCPCS-C8013-REMOVAL-HYPOGLOSSAL-NEUROSTIMULATOR-EXPLANT

HCPCS Level II C8013: Removal of Hypoglossal Neurostimulator Components

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Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or resources substantially exceed usual for this revascularization procedure due to complexity.
`23`	Unusual anesthesia	Use if general anesthesia is medically necessary and reported separately when anesthesia is otherwise not typical.
`50`	Bilateral procedure	Use if identical femoropopliteal revascularization is performed on both lower extremities (not typical for unilateral code `C7535`).
`51`	Multiple procedures	Use when multiple distinct procedures are performed at the same session in addition to the primary revascularization.
`52`	Reduced services	Use if the procedure is started but not completed or substantially reduced in scope.
`53`	Discontinued procedure	Use when the procedure is terminated due to extenuating circumstances prior to completion.
`59`	Distinct procedural service	Use to indicate a separate and distinct service when bundling edits might apply, e.g., separate diagnostic angiography versus therapeutic intervention.
`62`	Two surgeons	Use when co-surgeons of different specialties are required for a portion of the procedure.
`66`	Surgical team	Use when a surgical team approach is documented for complex open/endovascular hybrid cases.
`78`	Return to OR for related procedure during global period	Use if a related re-intervention for a complication occurs during the global period.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an approved advanced practice clinician is documented as assistant.
`LT`	Left side	Use to designate procedures performed on the left lower extremity when laterality is required.
`RT`	Right side	Use to designate procedures performed on the right lower extremity when laterality is required.
`QK`	Medical direction of two or more CRNAs/Anesthetists	Use when applicable to anesthesia medical direction during the procedure.

Taxonomy Code	Specialty	Notes
`334500000X`	Vascular Surgery	Primary specialty performing open and complex endovascular femoropopliteal interventions.
`208000000X`	Interventional Cardiology	Performs endovascular peripheral interventions in some centers; often involved for complex endovascular cases.
`207RG0300X`	Interventional Radiology	Commonly performs image-guided peripheral arterial interventions and IVUS-guided stent placement.
`208100000X`	Diagnostic Radiology	May perform the diagnostic angiography and radiological supervision and interpretation components.
`363L00000X`	Vascular Medicine	Involved in pre- and post-procedure medical management and outpatient vascular assessment.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.219`	Atherosclerosis of native arteries of the extremities, unspecified extremity, with intermittent claudication	Common indication for femoropopliteal revascularization to relieve claudication and improve perfusion.
`I70.231`	Atherosclerosis of native arteries of the extremities, right leg, with ulceration of calf	Indicates ischemic ulceration in the affected limb prompting revascularization.
`I70.232`	Atherosclerosis of native arteries of the extremities, left leg, with ulceration of calf	Same relevance for left-sided disease when intervention targets the left femoropopliteal segment.
`I70.33`	Atherosclerosis of bypass graft of the leg with ulceration	Relevant when restenosis or graft disease in femoropopliteal bypass graft requires endovascular treatment.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute limb ischemia scenarios that may necessitate urgent endovascular revascularization and stenting.
`I96`	Gangrene, not elsewhere classified	Advanced ischemic complications that can be an indication for revascularization to salvage limb.
`R02`	Gangrene, unspecified (or `I96` preferred)	Documentation of tissue loss or gangrene supports medical necessity for revascularization.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`93458`	Catheter placement, intravascular ultrasound (IVUS) during diagnostic and/or therapeutic procedures (coronary) — note: coronary-specific IVUS code; use of noncoronary IVUS is reported via the HCPCS code `C7535` rather than this CPT in many payor policies.	Not typically used for noncoronary lower extremity IVUS when `C7535` reports IVUS for initial noncoronary vessel; listed for contextual understanding.
`36012`	Introduction of needle or intracatheter for diagnostic angiography of peripheral vessels (example arterial puncture)	Performed at the start of an endovascular access session; supports vascular access documentation prior to femoropopliteal intervention.
`37220`	Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, with transluminal stent placement(s), includes angioplasty within the same vessel when performed	Represents a related peripheral arterial stent procedure at a different anatomic level; useful for coding cross-walks and bundling comparisons.
`37224`	Revascularization, endovascular, open or percutaneous, superficial femoral artery, with transluminal stent placement(s), unilateral, includes angioplasty within the same vessel when performed	Directly related code for superficial femoral interventions; may be considered in payer-specific coding determinations where CPT coding is required.
`75960`	Angiography, extremity, unilateral, radiological supervision and interpretation	Often reported for diagnostic peripheral angiography components when separate reporting is appropriate alongside therapeutic intervention.

Note: Data not available in the input for a specific list of related CPT codes; the codes above are commonly associated with femoropopliteal endovascular procedures and IVUS workflows and are provided for clinical and coding context.

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