2026 Lower Extremity Revascularization Codes for Interventional Cardiology, Part 1-Dr. Jeffrey Carr slides

Dr. Jeffrey Carr slides

Pdf Summary

The SCAI 2026 Lower Extremity Revascularization (LER) CPT coding updates reflect significant changes in code structure, payment, and clinical application, illustrated through a detailed iliac intervention case study. A 68-year-old male with progressive bilateral leg claudication underwent angiography revealing severe calcified occlusive disease in bilateral common and external iliac arteries, prompting complex endovascular intervention including balloon angioplasty, intravascular lithotripsy (IVL), and stenting via bilateral access approaches.<br /><br />Key 2026 CPT revisions include deleting 16 old codes (37220-37235) and introducing 46 new CPT codes (37254-37299), reorganizing vascular territories: common femoral artery (CFA) and profunda femoris artery (PFA) are grouped as a single territory; the infra-malleolar territory now includes the pedal arch. New intravascular lithotripsy codes (37262 for iliacs, reportable up to three times per leg; 37279 for femoral-popliteal, twice per leg) are added. The coding system retains separate codes for balloon angioplasty, atherectomy, and stenting but consolidates combinations of these procedures (e.g., PTA-stent, PTA-atherectomy).<br /><br />Lesions are categorized as “straightforward” stenosis or “complex” occlusions (any length). Coding requires reporting the most complex procedure per vessel treated; add-on codes apply only to additional vessels (not additional lesions within the same vessel). The reimbursement framework shows overall decreased work RVUs for straightforward cases but increased RVUs for complex interventions, reflecting in up to ~24-30% net revenue increases weighted by case complexity in iliac and femoral-popliteal territories. An example case’s coding captured multiple vessels treated with different complexity, utilizing primary and add-on CPT codes plus IVL, totaling 28.69 work RVUs.<br /><br />In summary, the 2026 CPT coding changes emphasize detailed vessel and lesion complexity classification, incorporate emerging technologies like IVL, and adjust payments favoring complex interventions, thereby enhancing precision and reimbursement alignment in peripheral vascular interventions.

Keywords

SCAI 2026

Lower Extremity Revascularization

LER CPT coding updates

iliac intervention case study

intravascular lithotripsy (IVL)

balloon angioplasty

atherectomy

calcium

laser

orbital

plaque

stenting

vascular territories reorganization

work RVUs reimbursement changes