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Peripheral Vascular Interventionsof the Lower Extremities2017 CODING AND REIMBURSEMENT GUIDECoverage, coding and reimbursement for medical procedures and devices can be confusing. This guide wasdeveloped to assist with Medicare reporting and reimbursement when performing transcatheter peripheral vascularangioplasty, atherectomy and stenting procedures of the lower extremities. If you have any questions, please contact ourreimbursement team at 800.468.1379 or by e-mail at Reimbursement@cookmedical.com.CoverageMedicare carriers may issue local coverage decisions (LCDs) listing criteria that must be met prior to coverage. Physiciansare urged to review these policies (http://www.cms.hhs.gov/mcd/search.asp?) and contact their carriers' medical directors(http://www.cms.hhs.gov/apps/contacts/) or commercial insurers to determine if a procedure is covered.CodingThe following CPT codes are used to report transcatheter peripheral vascular interventions for occlusive disease in thelower extremities. The codes are structured as a progressive hierarchy in which the more intensive services are inclusive ofthe lesser services. The bundled codes are broken down into three territories: iliac, femoral/popliteal and tibial/peroneal.The work of accessing and selectively catheterizing the vessel, traversing the lesion, radiological supervision andinterpretation directly related to the intervention(s) performed, embolic protection if used, closure of the arteriotomy bypressure and application of an arterial closure device or standard closure of the puncture by suture, and imagingperformed to document completion of the intervention in addition to the intervention(s) performed are included.1Iliac Vascular TerritoryThe iliac territory is divided into three vessels: common iliac, internal iliac and external iliac.37220Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty37221Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stentplacement(s), includes angioplasty within the same vessel, when performed 37222Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminalangioplasty (List separately in addition to code for primary procedure) 37223Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminalstent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code forprimary procedure)Primary codes are reported for the initial iliac artery treated in each leg. Add-on codes within the iliac territory are reported if morethan one vessel within the territory is treated. Do not report an add-on code for distinct lesions within the same vessel.1. American Medical Association. CPT 2017 Professional Edition. Chicago, IL: American Medical Association; 2016:253.Disclaimer: The information provided herein reflects Cook’s understanding of the procedure(s) and/or device(s) from sources that may include, but are not limited to, the CPT codingsystem; Medicare payment systems; commercially available coding guides; professional societies; and research conducted by independent coding and reimbursementconsultants. This information should not be construed as authoritative. The entity billing Medicare and/or third party payers is solely responsible for the accuracy of the codes assigned to theservices and items in the medical record. Cook does not, and should not, have access to medical records, and therefore cannot recommend codes for specific cases. When you are makingcoding decisions, we encourage you to seek input from the AMA, relevant medical societies, CMS, your local Medicare Administrative Contractor and other health plans to which yousubmit claims. Cook does not promote the off-label use of its devices.
Femoral/Popliteal Vascular TerritoryThe femoral/popliteal territory in one extremity is treated as one vessel. If more than one lesion is treated, report one code based onthe most intensive procedure(s) performed.37224Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty37225Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includesangioplasty within the same vessel, when performed37226Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stentplacement(s), includes angioplasty within the same vessel, when performed37227Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stentplacement(s) and atherectomy, includes angioplasty within the same vessel, when performedTibial/Peroneal TerritoryThe tibial/peroneal territory is divided into three vessels: anterior tibial, posterior tibial and peroneal arteries.37228Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; withtransluminal angioplasty37229Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy,includes angioplasty within the same vessel, when performed37230Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stentplacement(s), includes angioplasty within the same vessel, when performed37231Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stentplacement(s) and atherectomy, includes angioplasty within the same vessel, when performed 37232Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; withtransluminal angioplasty (List separately in addition to code for primary procedure) 37233Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; withatherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code forprimary procedure) 37234Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; withtransluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition tocode for primary procedure) 37235Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; withtransluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (Listseparately in addition to code for primary procedure)Primary codes are reported for the initial tibial/peroneal artery treated in each leg. Add-on codes within the tibial/peroneal territoryare reported if more than one vessel within the territory is treated. Do not report an add-on code for distinct lesions within the samevessel. The common tibioperoneal trunk is part of the tibial/peroneal territory and is not treated as a separate vessel.Disclaimer: The information provided herein reflects Cook’s understanding of the procedure(s) and/or device(s) from sources that may include, but are not limited to, the CPT codingsystem; Medicare payment systems; commercially available coding guides; professional societies; and research conducted by independent coding and reimbursementconsultants. This information should not be construed as authoritative. The entity billing Medicare and/or third party payers is solely responsible for the accuracy of the codes assigned to theservices and items in the medical record. Cook does not, and should not, have access to medical records, and therefore cannot recommend codes for specific cases. When you are makingcoding decisions, we encourage you to seek input from the AMA, relevant medical societies, CMS, your local Medicare Administrative Contractor and other health plans to which yousubmit claims. Cook does not promote the off-label use of its devices.
Payment2017 Medicare Reimbursement for Peripheral Vascular Interventions of the Lower Extremities—Physician and Outpatient FacilitiesAmbulatorySurgeryCenterCPTCodeProcedure DescriptionFacilityPaymentOutpatient HospitalPhysician ServicesFacility PaymentFee When ServiceIs Performed in theHospital or ASCFee When Service IsPerformedin the Office(National Medicare Avg3)(National Medicare Avg4)(National Medicare Avg4)(National Medicare Avg2)APC37220Revascularization, endovascular,open or percutaneous, iliac artery,unilateral, initial vessel; withtransluminal angioplasty 2,209.475192 4,823.16 422.77 3,113.7037221Revascularization, endovascular,open or percutaneous, iliac artery,unilateral, initial vessel; withtransluminal stent placement(s),includes angioplasty within the samevessel, when performed 6,047.535193 9,748.31 522.54 4,617.08 37222Revascularization, endovascular,open or percutaneous, iliac artery,each additional ipsilateral iliac vessel;with transluminal angioplasty (Listseparately in addition to code forprimary procedure) (Use 37222 inconjunction with 37220, 37221)Packaged serviceNo separate payment 196.67 873.89 37223Revascularization, endovascular,open or percutaneous, iliac artery,each additional ipsilateral iliac vessel;with transluminal stent placement(s),includes angioplasty within thesame vessel, when performed (Listseparately in addition to code forprimary procedure) (Use 37223 inconjunction with 37221)Packaged serviceNo separate paymentPackaged serviceNo separate payment 225.38 2,590.45 4,823.16 467.27 3,776.57Iliac Vascular TerritoryPackaged serviceNo separate paymentFemoral/Popliteal Vascular Territory37224Revascularization, endovascular,open or percutaneous, femoral,popliteal artery(s), unilateral; withtransluminal angioplasty 3,472.835192Continued on next pageDisclaimer: The information provided herein reflects Cook’s understanding of the procedure(s) and/or device(s) from sources that may include, but are not limited to, the CPT codingsystem; Medicare payment systems; commercially available coding guides; professional societies; and research conducted by independent coding and reimbursement consultants. Thisinformation should not be construed as authoritative. The entity billing Medicare and/or third party payers is solely responsible for the accuracy of the codes assigned to the services and items in themedical record. Cook does not, and should not, have access to medical records, and therefore cannot recommend codes for specific cases. When you are making coding decisions, we encourageyou to seek input from the AMA, relevant medical societies, CMS, your local Medicare Administrative Contractor and other health plans to which you submit claims. Cook does not promote theoff-label use of its devices.
AmbulatorySurgeryCenterCPTCodeProcedure DescriptionFacilityPaymentOutpatient HospitalPhysician ServicesFacility PaymentFee When ServiceIs Performed in theHospital or ASC(National Medicare Avg3)(National Medicare Avg4)5193 9,748.31 638.10 11,063.05(National Medicare Avg2 )APC 7,449.17Fee When Service IsPerformedin the Office(National Medicare Avg4)37225Revascularization, endovascular, openor percutaneous, femoral, poplitealartery(s), unilateral; with atherectomy,includes angioplasty within the samevessel, when performed37226Revascularization, endovascular, openor percutaneous, femoral, poplitealartery(s), unilateral; with transluminalstent placement(s), includesangioplasty within the same vessel,when performed 6,569.165193 9,748.31 550.89 9,065.1337227Revascularization, endovascular, openor percutaneous, femoral, poplitealartery(s), unilateral; with transluminalstent placement(s) and atherectomy,includes angioplasty within the samevessel, when performed 10,869.395194 14,775.90 769.09 14,986.7637228Revascularization, endovascular,open or percutaneous, tibial, peronealartery, unilateral, initial vessel; withtransluminal angioplasty 4,186.625193 9,748.31 572.78 5,408.7937229Revascularization, endovascular,open or percutaneous, tibial, peronealartery, unilateral, initial vessel; withatherectomy, includes angioplastywithin the same vessel, whenperformed 10,065.145194 14,775.90 746.13 10,905.8637230Revascularization, endovascular, openor percutaneous, tibial, peronealartery, unilateral, initial vessel; withtransluminal stent placement(s),includes angioplasty within the samevessel, when performed 10,088.265194 14,775.90 736.80 8,332.6437231Revascularization, endovascular,open or percutaneous, tibial, peronealartery, unilateral, initial vessel; withtransluminal stent placement(s) andatherectomy, includes angioplastywithin the same vessel, when performed 9,934.615194 799.60 13,492.72 37232Revascularization, endovascular, openor percutaneous, tibial/peronealartery, unilateral, each additionalvessel; with transluminal angioplasty(List separately in addition to codefor primary procedure) (Use 37232 inconjunction with 37228-37231) 213.18 1,206.94Tibial/Peroneal TerritoryPackaged serviceNo separate payment 14,775.90Packaged serviceNo separate paymentContinued on next pageDisclaimer: The information provided herein reflects Cook’s understanding of the procedure(s) and/or device(s) from sources that may include, but are not limited to, the CPT codingsystem; Medicare payment systems; commercially available coding guides; professional societies; and research conducted by independent coding and reimbursement consultants. Thisinformation should not be construed as authoritative. The entity billing Medicare and/or third party payers is solely responsible for the accuracy of the codes assigned to the services and items in themedical record. Cook does not, and should not, have access to medical records, and therefore cannot recommend codes for specific cases. When you are making coding decisions, we encourageyou to seek input from the AMA, relevant medical societies, CMS, your local Medicare Administrative Contractor and other health plans to which you submit claims. Cook does not promote theoff-label use of its devices.
dure Description(National Medicare Avg2) 37233Revascularization, endovascular, openor percutaneous, tibial/peronealartery, unilateral, each additionalvessel; with atherectomy, includesangioplasty within the same vessel,when performed (List separatelyin addition to code for primaryprocedure) (Use 37233 in conjunctionwith 37229, 37231)Packaged serviceNo separate payment 37234Revascularization, endovascular,open or percutaneous, tibial/peronealartery, unilateral, each additionalvessel; with transluminal stentplacement(s), includes angioplastywithin the same vessel, whenperformed (List separately in additionto code for primary procedure)(Use 37234 in conjunction with37229, 37230, 37231)Packaged serviceNo separate payment 37235Revascularization, endovascular,open or percutaneous, tibial/peroneal artery, unilateral, eachadditional vessel; with transluminalstent placement(s) and atherectomy,includes angioplasty within thesame vessel, when performed (Listseparately in addition to code forprimary procedure) (Use 37235 inconjunction with 37231)Outpatient HospitalAPCFacility PaymentFee When ServiceIs Performed in theHospital or ASCFee When Service IsPerformedin the Office(National Medicare Avg3)(National Medicare Avg4)(National Medicare Avg4) 346.33 1,458.88Packaged serviceNo separate payment 300.03 3,948.47Packaged serviceNo separate payment 415.95 4,242.04Packaged serviceNo separate paymentPackaged serviceNo separate paymentPhysician ServicesNote: Alternative payment policies may apply when multiple services are performed at the same encounter, including but not limited to, multipleprocedure payment reductions and comprehensive ambulatory payment classifications (C-APC).2. 2017 Medicare Ambulatory Surgery Center Fee Schedule3. 2017 Medicare Hospital Outpatient Prospective Payment System (OPPS) Fee Schedule4. 2017 Medicare Physician Fee ScheduleCPT 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.2017 physician fees for your local area can be found at the following CMS t/PhysicianFeeSched/index.htmlDisclaimer: The information provided herein reflects Cook’s understanding of the procedure(s) and/or device(s) from sources that may include, but are not limited to, the CPT codingsystem; Medicare payment systems; commercially available coding guides; professional societies; and research conducted by independent coding and reimbursement consultants. Thisinformation should not be construed as authoritative. The entity billing Medicare and/or third party payers is solely responsible for the accuracy of the codes assigned to the services and items in themedical record. Cook does not, and should not, have access to medical records, and therefore cannot recommend codes for specific cases. When you are making coding decisions, we encourageyou to seek input from the AMA, relevant medical societies, CMS, your local Medicare Administrative Contractor and other health plans to which you submit claims. Cook does not promote theoff-label use of its devices. COOK 2017RG PI PVILE RE 201701
The following CPT codes are used to report transcatheter peripheral vascular interventions for occlusive disease in the lower extremities. The codes are structured as a progressive hierarchy in which the more
