Summary & Overview
HCPCS C9754: Percutaneous Creation of Arteriovenous Fistula, Image-Guided
HCPCS Level II code C9754 denotes the percutaneous, direct creation of an arteriovenous fistula (AVF), inclusive of imaging, radiologic supervision and interpretation, and any secondary flow-redirecting procedures such as transluminal balloon angioplasty or coil embolization. This code matters nationally as minimally invasive AVF creation is increasingly used for vascular access in patients requiring hemodialysis and can impact site-of-service decisions, device utilization, and reimbursement pathways.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of clinical context for percutaneous AVF creation, benchmarks and coverage considerations where available, and a summary of relevant coding and service-line implications for hospital outpatient departments and ambulatory surgical centers. The publication outlines typical use cases, expected service settings, and what to expect in terms of bundled imaging and adjunctive procedures. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code C9754 describes the percutaneous creation of an arteriovenous fistula (AVF) by direct access at any site. The procedure includes all imaging and radiologic supervision and interpretation when performed, and may include secondary procedures performed to redirect blood flow, such as transluminal balloon angioplasty or coil embolization.
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Service type: Image-guided, percutaneous vascular access procedure to create an arteriovenous fistula
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Typical site of service: Hospital outpatient departments, ambulatory surgical centers, and interventional radiology suites where image guidance and radiologic interpretation are available
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with end-stage renal disease (ESRD) requiring hemodialysis is scheduled for percutaneous creation of an arteriovenous fistula to establish durable vascular access. The patient has an adequate arterial inflow vessel and a suitable venous outflow target on pre-procedure duplex ultrasound. On the day of service the patient arrives fasting, undergoes pre-procedure evaluation including review of medications (anticoagulants managed per protocol), informed consent, and pre-procedure imaging verification. Under conscious sedation or monitored anesthesia care, the interventional radiologist or vascular surgeon gains percutaneous arterial and/or venous access, uses fluoroscopic and ultrasound guidance to create the direct arteriovenous connection, and performs intra-procedural imaging for device positioning and flow assessment. Secondary endovascular maneuvers such as transluminal balloon angioplasty or coil embolization may be performed during the same session to redirect flow or optimize maturation. Post-procedure, the patient is observed for access site hemostasis, immediate complications, and receives instructions for fistula care and follow-up surveillance imaging.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician’s interpretation portion if facility bills separately |