C8004 Simulation Angiogram HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS C8004: Simulation Angiogram for Radioembolization Planning

HCPCS Level II code C8004 represents a simulation angiogram using a pressure-generating catheter, performed to plan therapeutic radioembolization for tumors. The code bundles radiological supervision and interpretation, intraprocedural roadmapping, and all imaging guidance necessary to complete the angiographic simulation. This code matters nationally as radioembolization is an established locoregional therapy for liver and other tumor sites, and accurate simulation angiography is critical to target delivery, assess vascular anatomy, and reduce non-target radiation.

Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on the clinical role of the procedure, payer coverage patterns, and commonly reported modifiers associated with this service. The publication also outlines the service line context (interventional radiology), typical sites of service (hospital IR suites and outpatient IR centers), and practical coding considerations relevant to billing teams and clinical administrators.

This summary provides national-level context for administrators and coding professionals seeking to understand how C8004 is used in practice, what clinical purpose it serves in the radioembolization care pathway, and which payers commonly appear in coverage discussions. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC8004HCPCS Level IIsimulation angiogramradioembolizationinterventional radiologyimage-guided procedureangiographyprocedure coding

Billing Code Overview

HCPCS Level II code C8004 describes a simulation angiogram with use of a pressure-generating catheter (for example, a one-way valve or an intermittently occluding catheter). The service is inclusive of radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance required to complete the angiogram. The procedure is performed as a planning simulation for subsequent therapeutic radioembolization of tumors.

Service type: Image-guided vascular simulation procedure for radioembolization planning
Typical site of service: Hospital-based interventional radiology suite or outpatient interventional radiology center

Clinical & Coding Specifications

Clinical Context

A 65-year-old patient with unresectable hepatic metastases from colorectal cancer is scheduled for selective internal radiation therapy (radioembolization / Y-90). Prior to therapeutic delivery, the interventional radiology team performs a simulation angiogram using a pressure-generating catheter (e.g., one-way valve or intermittently occluding catheter) to map tumor arterial supply, evaluate vascular anatomy, and simulate microsphere distribution. The procedure is performed in an angiography suite or interventional radiology procedure room equipped for fluoroscopy and cone-beam CT.

The clinical workflow: the patient arrives fasting, consents for angiography and possible embolization-related procedures, and receives moderate sedation or monitored anesthesia care per institutional policy. Vascular access (commonly common femoral artery or radial artery) is obtained under ultrasound guidance. Diagnostic angiography of the celiac axis and superior mesenteric artery is performed, followed by selective catheterization of hepatic arterial branches. The pressure-generating catheter is used to provide controlled flow conditions and intraprocedural roadmapping while contrast and/or technetium-99m macroaggregated albumin (99mTc-MAA) simulation injections are performed to assess tumor perfusion and non-target embolization risk. Real-time imaging guidance and radiological supervision and interpretation are provided throughout. Post-procedure imaging review (including angiographic runs and nuclear medicine simulation images) informs treatment planning for subsequent therapeutic radioembolization. Vascular closure is performed and the patient recovers in the post-anesthesia care unit with standard post-angiography monitoring and discharge instructions or admission as indicated.

Coding Specifications

Modifier	Description	When to Use

HCPCS C9043: Levoleucovorin Injection, 1 mg

HCPCS-C1742-IMPLANTABLE-INTRAMUSCULAR-PRESSURE-MONITORING-SYSTEM

HCPCS C1742: Implantable Intramuscular Continuous Pressure Monitoring System

HCPCS-C1839-IRIS-PROSTHESIS-IMPLANT

HCPCS Level II C1839: Iris Prosthesis

HCPCS-C9773-TIBIAL-PERONEAL-REVASCULARIZATION-LITHOTRIPSY-STENT

HCPCS C9773: Tibial/Peroneal Artery Revascularization with Lithotripsy and Stent

HCPCS-C8900-MAGNETIC-RESONANCE-ANGIOGRAPHY-ABDOMEN-CONTRAST

HCPCS C8900: Magnetic Resonance Angiography with Contrast, Abdomen

HCPCS-C2613-LUNG-BIOPSY-PLUG-DELIVERY-SYSTEM

HCPCS C2613: Lung Biopsy Plug with Delivery System

HCPCS-C9145-APREPITANT-INJECTION-1MG-APONVIE

HCPCS Level II C9145: Aprepitant (Aponvie) Injection, 1 mg

HCPCS-C9053-CRIZANLIZUMAB-INJECTION-1MG

HCPCS C9053: Crizanlizumab-tmca Injection, 1 mg

HCPCS-C9451-PERAMIVIR-INJECTION-1MG

HCPCS C9451: Peramivir Injection, 1 mg

HCPCS-C9750-INTRACARDIAC-ISCHEMIA-MONITORING-SYSTEM-INSERTION-REPLACEMENT

HCPCS C9750: Intracardiac Ischemia Monitoring System Insertion/Replacement

Showing 1–10 of 603

`00`	No modifier	Use when no modifier applies; report the service as standard.
`22`	Increased procedural services	Use when work required is substantially greater than typically required (e.g., unusually complex vascular anatomy requiring additional time).
`23`	Unusual anesthesia	Use when general anesthesia is medically required for this angiographic simulation.
`52`	Reduced services	Use when the simulation angiogram is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to extenuating circumstances (e.g., hemodynamic instability).
`54`	Surgical care only	Use when another provider performs pre- and post-procedural care and the billing provider only performs the angiographic procedure portion.
`55`	Postoperative management only	Use when only the post-procedural management is performed by the billing provider.
`56`	Preoperative management only	Use when only pre-procedural work-up and clearance are performed by the billing provider.
`62`	Two surgeons	Use when two qualified practitioners from different specialties perform distinct portions of care during the angiographic planning procedure.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use if an advanced practice provider assists during the procedure and facility/payor requires the modifier for billing.
`CQ`	Service furnished as part of a CMMI (Comprehensive Primary Care Plus) model	Use when relevant for programs requiring this modifier.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals	Use if the physician directs multiple concurrent anesthesia services during the angiographic simulation.
`QX`	CRNA service: CRNA with medical direction by a physician	Use when a certified registered nurse anesthetist provides anesthesia under physician direction.
`QY`	Medical direction of one certified registered nurse anesthetist by an anesthesiologist	Use when an anesthesiologist medically directs a CRNA for this case.

Taxonomy Code	Specialty	Notes
`207P00000X`	Interventional Radiology	Primary specialty performing simulation angiography and radioembolization planning.
`207K00000X`	Diagnostic Radiology	May perform angiographic studies and interpret imaging guidance.
`2080P0002X`	Vascular Surgery	May be involved when complex vascular access or vessel reconstruction considerations exist.
`208100000X`	General Surgery	Occasionally involved for peri-procedural surgical considerations in complex cases.
`363L00000X`	Nuclear Medicine	Interprets 99mTc-MAA simulation imaging and assists with dosimetry planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C78.7`	Secondary malignant neoplasm of liver and intrahepatic bile duct	Common indication for liver-directed simulation angiography prior to radioembolization.
`C78.0`	Secondary malignant neoplasm of lung	May coexist with hepatic metastases; relevant for overall treatment planning though not a direct indication for hepatic simulation.
`C22.0`	Liver cell carcinoma	Primary hepatic malignancy that may be treated with radioembolization; simulation angiogram used for planning.
`C76.2`	Malignant neoplasm of retroperitoneum and peritoneum	Tumors with hepatic involvement or nearby vascular considerations may prompt mapping.
`K76.81`	Portal hypertension	Vascular alterations can affect catheterization strategy and risk assessment during simulation angiography.
`I82.90`	Acute embolism and thrombosis of unspecified vein	Vascular thrombotic disease may influence access site selection and procedural risk assessment.
`Z92.3`	Personal history of irradiation	Relevant to planning further hepatic-directed radiotherapy and cumulative dose considerations.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36215`	Selective catheterization, arterial system; each first order thoracic, abdominal branch vessel, or noncoronary organ (List separately in addition to code for primary procedure)	Often used for selective catheterization of hepatic arterial branches during simulation angiography.
`36216`	Selective catheterization, each additional first order branch vessel, when performed	Use for additional selective catheterizations beyond the first vessel during mapping.
`37193`	Transcatheter therapy, percutaneous, radiological supervision and interpretation; any method, including arterial infusion for tumor therapy (selective)	May represent therapeutic transcatheter delivery procedures performed subsequently, linked to simulation planning.
`36247`	Endovascular placement of intravascular catheter(s), percutaneous, with angioplasty when performed; each additional catheter or vessel	Used if additional catheter maneuvers or devices are placed as part of the simulation setup.
`76937`	Ultrasound guidance for vascular access requiring imaging documentation	Used when ultrasound guidance is used for arterial access prior to angiography.

OpenPayer