C7563 Transluminal Balloon Angioplasty HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS C7563: Transluminal Balloon Angioplasty, Non-Excluded Arteries

HCPCS Level II code C7563 represents transluminal balloon angioplasty (open or percutaneous) for arteries other than lower extremity arteries for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuits. The code bundles the angioplasty procedure with all necessary imaging and radiological supervision and interpretation for the initial artery and any additional arteries treated in the same session. This procedure code matters nationally because it standardizes reporting for a range of peripheral angioplasty procedures and informs claims processing, utilization monitoring, and payment policy across major payers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical procedure captured by C7563, typical sites of service where the procedure is performed, and what to expect in payment and coding contexts. The publication provides benchmarks where available, discusses relevant policy and coverage considerations at a national level, and places the code in clinical context to aid billing and revenue cycle professionals. Data not available in the input is explicitly noted where applicable.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareC7563HCPCS Level IIangioplastyinterventional radiologypercutaneous procedureshospital outpatientambulatory surgery centerimagingradiology supervision

Billing Code Overview

HCPCS Level II code C7563 describes transluminal balloon angioplasty (except lower extremity arteries for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit) performed open or percutaneously. The description includes all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, for the initial artery and any additional arteries treated during the same encounter.

Service Type: Percutaneous or open transluminal balloon angioplasty of non-excluded arteries, inclusive of imaging and radiological supervision and interpretation.

Typical Site of Service: Hospital outpatient department, ambulatory surgery center, or interventional radiology suite depending on clinical setting and patient status.

Data not available in the input for Associated Taxonomies, ICD-10 Diagnoses, Related Codes, and Service Line.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with progressive intermittent claudication and lifestyle-limiting exertional leg pain is evaluated in the vascular surgery clinic. Noninvasive vascular testing (ankle-brachial index and duplex ultrasound) demonstrates focal atherosclerotic stenosis in a femoropopliteal artery. The patient has failed optimal medical therapy and supervised exercise and is scheduled for transluminal balloon angioplasty to restore luminal diameter.

On the day of service the patient presents to an outpatient vascular suite or hospital-based interventional radiology/vascular surgery lab. Pre-procedure informed consent, pre-procedure antibiotics if indicated, vascular access planning (typically common femoral artery), and image guidance review are completed. Under conscious sedation or monitored anesthesia care, arterial access is obtained, diagnostic angiography is performed to localize the lesion, and balloon angioplasty of the target superficial femoral or popliteal artery is performed. All intra-procedural imaging and radiological supervision and interpretation required to perform the angioplasty within the same artery are provided. Post-procedure hemostasis, monitoring in PACU or observation unit, and discharge instructions or inpatient admission as clinically indicated complete the workflow.

Typical site of service: outpatient hospital-based interventional radiology or vascular surgery suite, ambulatory surgical center, or inpatient operating room depending on comorbidity and anesthesia needs.

Service type: endovascular transluminal balloon angioplasty (open or percutaneous) of non-coronary, non-intracranial, non-pulmonary, non-dialysis circuit peripheral arteries (excluding lower extremity occlusive disease procedures that have distinct codes).

Coding Specifications

Modifier	Description	When to Use

Related Codes

HCPCS-C1776-JOINT-DEVICE-IMPLANTABLE

HCPCS C1776: Joint Device (Implantable)

HCPCS-C7564-PERCUTANEOUS-MECHANICAL-THROMBECTOMY-VEIN-WITH-IMAGE-GUIDANCE

HCPCS C7564: Percutaneous Mechanical Thrombectomy of Vein(s) with Image Guidance

HCPCS-C7565-RECURRENT-ANTERIOR-ABDOMINAL-HERNIA-REPAIR-MESH-REMOVAL

HCPCS C7565: Recurrent Anterior Abdominal Hernia Repair with Mesh Removal

HCPCS-C7550-CYSTOURETHROSCOPY-BIOPSY-BLUE-LIGHT-FLUORESCENT-IMAGING

HCPCS C7550: Cystourethroscopy with Biopsy Using Blue Light Fluorescent Imaging

HCPCS-C1789-BREAST-IMPLANTABLE-PROSTHESIS

HCPCS C1789: Implantable Breast Prosthesis

HCPCS-C9461-CHOLINE-C11-PET-DIAGNOSTIC-STUDY-DOSE

HCPCS C9461: Choline C 11 Diagnostic PET Study Dose

HCPCS-C9782-TRANSCATHETER-INTRAMYOCARDIAL-CELL-TRANSPLANTATION

HCPCS C9782: Transcatheter Intramyocardial Autologous Bone Marrow Transplantation

HCPCS-C7507-PERCUTANEOUS-VERTEBRAL-AUGMENTATION-THORACIC-LUMBAR

HCPCS C7507: Percutaneous Vertebral Augmentation, Thoracic/Lumbar

HCPCS-C9765-LOWER-EXTREMITY-INTRAVASCULAR-LITHOTRIPSY-STENT-PLACEMENT

HCPCS C9765: Lower Extremity Revascularization with Lithotripsy and Stent Placement

HCPCS-C9031-LUTETIUM-LU177-DOTATATE-THERAPEUTIC-1MCI

HCPCS Level II C9031: Lutetium Lu 177 Dotatate Therapeutic, 1 mCi

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Taxonomy Code	Specialty	Notes
`207W00000X`	Vascular Surgery	Primary surgical specialty performing peripheral angioplasty.
`207X00000X`	Interventional Cardiology	Performs peripheral vascular interventions in some centers.
`1744P0005X`	Interventional Radiology	Commonly performs endovascular angioplasty with imaging guidance.
`206E00000X`	General Surgery	May perform peripheral endovascular procedures in some hospitals.
`2085R0202X`	Anesthesiology	Provides monitored anesthesia care or general anesthesia for complex cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.219`	Atherosclerosis of native arteries of the extremities, unspecified extremity, with intermittent claudication	A common indication for peripheral transluminal balloon angioplasty to relieve symptomatic stenosis.
`I70.201`	Atherosclerosis of native arteries of the extremities, right leg, uncomplicated	Defines site-specific atherosclerotic disease targeted by angioplasty.
`I70.202`	Atherosclerosis of native arteries of the extremities, left leg, uncomplicated	Left-sided counterpart indicating target lesion for endovascular therapy.
`I70.213`	Atherosclerosis of native arteries of the extremities, unspecified extremity, with rest pain	Used when ischemic rest pain prompts revascularization by angioplasty.
`I73.9`	Peripheral vascular disease, unspecified	Broad diagnosis often used as supporting clinical indication for angioplasty when specifics are not documented.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36010`	Introduction of needle or intracatheter, central vein; diagnostic, not used for arterial access but commonly billed for central venous access when required for monitoring or medications during the procedure.	May be performed contemporaneously if central venous access is obtained for medication or monitoring during complex cases.
`36200`	Angiography, diagnostic, peripheral, noncoronary, arterial, radiological supervision and interpretation	Performed immediately before angioplasty to define arterial anatomy and lesion location; provides baseline imaging.
`35476`	Endovascular revascularization, open or percutaneous, femoral/popliteal, transluminal balloon angioplasty	Commonly paired or used synonymously for lower extremity angioplasty procedures; used depending on exact anatomic descriptor and payer rules.
`37220`	Revascularization, endovascular, open or percutaneous, with transluminal angioplasty, peripheral artery(ies), initial vessel	Represents peripheral arterial angioplasty and may be used for coding when procedure maps to CPT guidelines.
`76937`	Ultrasound guidance for vascular access	Used when ultrasound guidance is used for arterial access prior to angioplasty.

`22`	Increased procedural services	Use when work required to perform angioplasty substantially exceeds typical performance (document rationale and additional work).
`23`	Unusual anesthesia	Use when general anesthesia is administered for an otherwise MAC/sedation procedure and the payer requires reporting.
`50`	Bilateral procedure	Use when identical procedures are performed on paired arteries bilaterally during the same session.
`51`	Multiple procedures	Use when additional distinct procedures are performed in the same operative session; follow payer bundling rules.
`52`	Reduced services	Use when the angioplasty is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when the procedure is started but halted for patient safety before completion.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the angioplasty.
`AS`	Ambulatory surgical center (facility)	Use to indicate the procedure was performed in an ASC for payers that require the `AS` modifier.
`QK`	Medical direction of two or three anesthesia providers	Use when the reporting anesthesiologist medically directs multiple certified registered nurse anesthetists for the case.