Summary & Overview
HCPCS C9775: Tibial/Peroneal Revascularization with Lithotripsy, Stent, Atherectomy
HCPCS Level II code C9775 denotes a complex peripheral arterial revascularization procedure for the tibial and peroneal arteries that combines intravascular lithotripsy, atherectomy, transluminal stent placement, and angioplasty when performed. This bundled, device- and technique-intensive code captures advanced limb-salvage and revascularization care for patients with significant below-knee arterial disease. Nationally, the code matters because it reflects growing use of multidisciplinary endovascular and hybrid approaches to treat complex peripheral artery disease and affects facility and payer arrangements for high-resource interventions.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and sites of service, an explanation of the procedure components coded by C9775, and pointers to the types of benchmarks and policy topics typically associated with such complex endovascular services — for example, reimbursement bundling, coding guidance for combined device use, and implications for hospital outpatient versus inpatient settings. The publication outlines where to expect variability across payers and what areas commonly drive coverage and payment discussions, while noting any missing input fields as Data not available in the input.
Billing Code Overview
HCPCS Level II code C9775 describes revascularization of the tibial/peroneal arteries using a combination of endovascular, open, or percutaneous techniques that include intravascular lithotripsy, transluminal stent placement(s), and atherectomy, and also includes angioplasty within the same vessel(s) when performed. The procedure targets disease of the tibial and peroneal arterial segments of the lower extremity.
Service Type: Complex peripheral arterial revascularization with adjunctive plaque modification and stenting
Typical Site of Service: Hospital outpatient setting or inpatient operating room/vascular hybrid suite, with cases also performed in specialized endovascular labs.
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with diabetes mellitus, chronic kidney disease stage 3, and a history of peripheral arterial disease presents with ischemic rest pain and a non-healing ulcer of the foot. Noninvasive testing (ABI, toe pressures, duplex ultrasound) demonstrates hemodynamically significant tibial artery disease with diffuse calcified stenoses of the anterior tibial and peroneal arteries. The vascular surgery and interventional cardiology teams plan an endovascular revascularization of the tibial/peroneal arterial segment. The procedure includes intravascular lithotripsy to treat heavily calcified lesions, atherectomy to debulk plaque, balloon angioplasty, and placement of one or more transluminal stents within the treated tibial/peroneal vessels.
The clinical workflow: pre-procedure assessment and informed consent; review of recent labs (including renal function) and ankle-brachial index; peri-procedural antibiotics per hospital policy; arterial access (usually femoral or retrograde tibial access) under fluoroscopic guidance; intravascular diagnostic angiography; intravascular lithotripsy to fracture medial calcium; atherectomy to remove atheromatous material where indicated; balloon angioplasty; deployment of tibial/peroneal stent(s); completion angiography to confirm flow; hemostasis and post-procedure monitoring. Post-procedure care includes vascular exam checks, wound care for the foot ulcer, adjustment of antiplatelet therapy, and coordination with the primary care and wound care teams for follow-up and surveillance imaging.
Coding Specifications
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