2026 Lower Extremity Revascularization Codes for Interventional Cardiology, Part 1-Coding Guidelines for Peripheral Interventions 2026

Coding Guidelines for Peripheral Interventions 2026

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This document provides comprehensive guidelines and coding instructions for peripheral vascular interventions, focusing on coverage, indications, and appropriate CPT coding procedures.<br /><br />Coverage and Indications:<br />Medicare and other payers cover non-coronary vascular stents and percutaneous transluminal angioplasty (PTA) with stenting only if thorough medical evaluation and management have been done, and surgery is considered an alternative. Primary stenting is justified in cases where angioplasty alone is unlikely to yield durable results, including certain occlusions, calcified or difficult lesions, and specific vascular compressions. Approved uses cover a range of vascular territories including brachiocephalic arteries (e.g., subclavian steal syndrome), pulmonary arteries (congenital stenosis), renal arteries (dissection, aneurysm, resistant hypertension), lower extremity arteries (critical limb ischemia), mesenteric vessels, venous access for hemodialysis grafts/fistulas, and superior/inferior vena cava or iliofemoral veins for stenosis or thrombosis.<br /><br />Sequential interventions (e.g., surgery, angioplasty, atherectomy, stenting) are acceptable if prior treatment is unsuccessful. Preventive stenting without symptoms is not covered.<br /><br />Coding Guidelines:<br />The codes detailed cover multiple vascular territories (iliac, femoral/popliteal, tibial/peroneal, inframalleolar) and include angioplasty, stenting, atherectomy, lithotripsy, embolization, IVUS, thrombectomy, thrombolysis, and vena cava filter procedures. Coding instructions specify use of initial and add-on codes per vessel and lesion complexity (straightforward vs complex). Multiple procedures in the same vessel are consolidated into single codes. Separate reporting is required for catheter placements, imaging, ultrasound guidance, thrombolysis, and embolization fields.<br /><br />Special notes include:<br />- Use of FDA-approved devices and embolic protection for Transcatheter Carotid Artery Revascularization (TCAR).<br />- Documentation and shared decision-making are mandatory.<br />- Coverage determinations are subject to payer-specific requirements and prior authorization.<br /><br />References include AMA CPT manuals and CMS LCD policies.<br /><br />Overall, this guidance assists clinicians and coders in appropriately documenting, coding, and justifying peripheral vascular interventions consistent with payer policies.

Keywords

Peripheral vascular interventions

CPT coding guidelines

Medicare coverage

Non-coronary vascular stents

Percutaneous transluminal angioplasty (PTA)

Sequential vascular procedures

Vascular territories

Embolization procedures

Transcatheter Carotid Artery Revascularization (TCAR)

Payer authorization requirements