Summary & Overview
HCPCS C9765: Lower Extremity Revascularization with Lithotripsy and Stent Placement
HCPCS Level II code C9765 designates revascularization of lower extremity arteries (excluding tibial/peroneal) that combines intravascular lithotripsy with transluminal stent placement and may include angioplasty in the same vessel(s). This hybrid endovascular/percutaneous procedure addresses calcified peripheral arterial disease and reflects advances in intravascular plaque modification techniques that enable effective stent deployment in challenging lesions. Nationally, the code matters because it standardizes reporting for a complex, resource-intensive peripheral vascular intervention with implications for clinical documentation, device utilization, and hospital and ambulatory surgical center billing.
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 context for the procedure, typical sites of service, and the elements that distinguish C9765 from other peripheral vascular procedure codes. The publication also summarizes benchmark considerations such as procedure complexity, expected resource use, and common billing modifiers and service-line implications. Policy and coverage themes include payer recognition of intravascular lithotripsy combined with stenting, documentation needs to support medical necessity, and coding alignment for accurate claims adjudication. Data not available in the input for specific reimbursement rates, payer-specific coverage rules, ICD-10 pairings, and related codes.
Billing Code Overview
HCPCS Level II code C9765 describes a lower extremity arterial revascularization procedure performed by endovascular, open, or percutaneous approaches. The code specifically captures procedures on lower extremity artery(ies), excluding tibial and peroneal vessels, that include intravascular lithotripsy and transluminal stent placement(s), and that may include angioplasty within the same vessel(s) when performed.
Service Type: Peripheral vascular intervention with intravascular lithotripsy and stent placement
Typical Site of Service: Hospital outpatient department or inpatient operating room / vascular interventional suite, and ambulatory surgical center when clinically appropriate.
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with a history of peripheral artery disease (PAD), chronic smoking, hypertension, and poorly controlled diabetes presents with worsening right calf claudication and ischemic rest pain. Noninvasive testing (ankle-brachial index and duplex ultrasound) demonstrates a hemodynamically significant stenosis of the right common femoral and superficial femoral artery with heavily calcified plaque. Vascular surgery and interventional radiology evaluate the patient; imaging (CT angiography) confirms a focal, heavily calcified lesion in the lower extremity arterial segment above the tibial/peroneal vessels.
The clinical workflow includes pre-procedure evaluation and informed consent, periprocedural antiplatelet management, and scheduling in a hospital-based vascular hybrid operating room or endovascular suite. The procedure performed is endovascular lower extremity revascularization (excluding tibial/peroneal territory) using intravascular lithotripsy to modify calcified plaque followed by angioplasty and placement of one or more transluminal stents in the same vessel(s). Intra-procedural angiography confirms vessel patency and adequate flow. Post-procedure, the patient is observed for access site complications, receives post-op antiplatelet therapy, and is discharged with follow-up for wound checks and duplex surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use when no other modifier is applicable and full professional/technical services are furnished. |