Summary & Overview
HCPCS C9767: Lower Extremity Revascularization with Lithotripsy, Stent, Atherectomy
HCPCS Level II code C9767 captures a complex lower extremity arterial revascularization that combines intravascular lithotripsy, transluminal stent placement, and atherectomy, and includes angioplasty when performed. This code is significant nationally because it documents advanced hybrid endovascular and surgical techniques used to treat peripheral arterial disease (PAD) outside the tibial/peroneal segment, reflecting growing adoption of intravascular lithotripsy and combined-device strategies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for use of C9767, typical sites of service, and payer coverage considerations. The publication summarizes available benchmarks and utilization patterns where present, highlights relevant policy and coding guidance updates, and explains common billing and documentation themes associated with complex peripheral revascularization services.
This national-level summary is intended for coding professionals, billing teams, vascular clinicians, and policy analysts who need concise information about the code’s clinical scope, procedural setting, and how major payers approach coverage and administration for advanced lower extremity revascularization procedures.
Billing Code Overview
HCPCS Level II code C9767 describes revascularization of lower extremity artery(ies), except tibial/peroneal, performed by endovascular, open, or percutaneous approaches. The procedure specifically includes intravascular lithotripsy, transluminal stent placement(s), and atherectomy, and it includes angioplasty within the same vessel(s) when performed.
Service type: Complex peripheral arterial revascularization with adjunctive intravascular lithotripsy, stenting, and atherectomy.
Typical site of service: Hospital outpatient department or inpatient vascular surgery/interventional suites; may also occur in specialized ambulatory surgical centers capable of complex endovascular and hybrid vascular procedures.
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with progressive lifestyle-limiting left lower extremity claudication and a history of peripheral artery disease presents for endovascular revascularization. Noninvasive arterial studies show an ankle-brachial index of 0.55 on the left with duplex ultrasound and CTA confirming a heavily calcified focal lesion in the superficial femoral artery with associated flow-limiting stenosis. The interventional vascular team evaluates the patient for an endovascular-first approach. Under conscious sedation in an outpatient endovascular suite or hospital interventional radiology/cardiac catheterization lab, arterial access is obtained (commonly common femoral). The procedure plan includes atherectomy to debulk plaque, intravascular lithotripsy to fracture deep arterial calcium, balloon angioplasty, and placement of one or more transluminal stents to restore lumen diameter and durable flow in the same treated vessel(s). Peri-procedural workflow includes pre-procedure consent and medication reconciliation, vascular access and heparinization, intraprocedural angiography to guide device selection, sequential use of atherectomy and lithotripsy devices, stent deployment, post-dilation/angioplasty as needed, hemostasis, and post-procedure monitoring for access-site complications, limb perfusion, and discharge planning. Typical sites of service are hospital outpatient department, ambulatory surgical center with vascular capability, or inpatient interventional radiology/cardiac catheterization lab when clinically indicated.
Coding Specifications
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