Summary & Overview
HCPCS Level II C9764: Lower Extremity Revascularization with Intravascular Lithotripsy
HCPCS Level II code C9764 designates lower extremity arterial revascularization (excluding tibial/peroneal arteries) that incorporates intravascular lithotripsy and may include angioplasty within the same vessel(s). The code captures advanced plaque-modifying techniques used in peripheral arterial disease (PAD) management and is relevant as intravascular lithotripsy gains clinical adoption for calcified lesions. Nationally, this code matters for procedural classification, payer coverage policies, and facility billing across inpatient, outpatient, and ambulatory surgical settings.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent and applicable service settings, a summary of common modifiers and billing considerations, and benchmarking context where available. The publication also highlights policy and coverage dynamics affecting reimbursement and utilization tracking for intravascular lithotripsy in lower extremity revascularization.
The report is organized to provide quick reference: an executive synopsis, coding details and descriptors, payer coverage notes, typical sites of service, and practical billing considerations for facilities and clinicians. Data not provided in the input (such as associated taxonomies, specific ICD-10 pairings, or related codes) is noted as unavailable and excluded from detailed tables.
Billing Code Overview
HCPCS Level II code C9764 describes revascularization of lower extremity artery(ies) — performed via endovascular, open, or percutaneous approaches — excluding tibial/peroneal arteries, and includes intravascular lithotripsy with angioplasty in the same vessel(s) when performed. This procedure targets plaque modification and vessel lumen restoration in non-tibial lower extremity arteries using intravascular lithotripsy as part of the revascularization strategy.
Service type: Endovascular and/or open peripheral arterial revascularization with intravascular lithotripsy and angioplasty.
Typical site of service: Hospital inpatient, hospital outpatient, or ambulatory surgical center (ASC) depending on procedural approach and clinical status.
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with a history of peripheral artery disease, smoking, hyperlipidemia, and type 2 diabetes presents with lifestyle-limiting claudication of the right thigh and buttock and ankle-brachial index (ABI) of 0.55. Noninvasive vascular testing (duplex ultrasound and CT angiography) demonstrates significant atherosclerotic calcified stenosis of the common and external iliac arteries and proximal superficial femoral artery (SFA) with heavy circumferential calcification and a short focal eccentric plaque in the common femoral artery. The interventional vascular team elects to perform lower extremity arterial revascularization using endovascular technique with intravascular lithotripsy to modify heavily calcified plaque, followed by angioplasty and selective stent placement if needed.
Pre-procedure workflow includes vascular surgery or interventional cardiology consultation, informed consent discussing intravascular lithotripsy, pre-procedure labs (CBC, BMP, coagulation studies), review of antiplatelet/anticoagulant medications, and anesthesia assessment. In the angiography suite, arterial access is obtained (typically common femoral or radial access), baseline angiography performed to localize lesions, and intravascular lithotripsy delivered to the affected iliac/SFA segments. Post-lithotripsy angioplasty is performed in the same vessel(s); adjunctive stenting may follow if significant residual stenosis or flow-limiting dissection occurs. Post-procedure monitoring includes vascular access site observation, hemodynamic monitoring, and ABI comparison prior to discharge with follow-up outpatient surveillance duplex imaging and secondary prevention therapy optimization.
Coding Specifications
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