2026 Lower Extremity Revascularization Codes for Interventional Cardiology, Part 1-Monica Wright slides

Monica Wright slides

Pdf Summary

The Society for Cardiovascular Angiography and Interventions (SCAI) provides updated 2026 CPT coding guidelines for lower extremity revascularization procedures in the iliac and femoral popliteal vascular territories. The prior codes 37220–37235 have been deleted and replaced with 45 new codes divided into four distinct vascular territories: iliac, femoral popliteal, tibial peroneal, and inframalleolar.<br /><br />Iliac territory includes common, internal, and external iliac arteries. Procedures are categorized into angioplasty (codes 37254, 37256), stenting (37258, 37260), and lithotripsy (37262). Codes differentiate straightforward versus complex lesions and allow for add-on codes for additional vessels per extremity but not for multiple lesions within the same vessel. Lithotripsy can be reported up to three times per leg. Iliac atherectomy uses CPT 0238T. Bilateral procedures should use modifier 50 for base codes and modifier 59 for add-on codes.<br /><br />Femoral popliteal territory covers common femoral, profunda femoris, superficial femoral, and popliteal arteries—with common femoral and profunda femoris considered one vessel and superficial femoral and popliteal another. New codes (e.g., angioplasty 37263, 37265; stenting 37267, 37269; atherectomy 37271, 37273; combined procedures 37275, 37277; lithotripsy 37279) similarly distinguish straightforward and complex lesions. Only one add-on code per additional vessel is allowed per leg, and lithotripsy may be reported twice per leg.<br /><br />Across territories, a single primary/base code should be used per vascular territory based on the most complex lesion treated, with add-on codes for additional vessels but not for multiple lesions in the same vessel. Procedures include all necessary interventions such as lesion crossing, imaging guidance, embolic protection, and access closure.<br /><br />These coding changes reflect refined granularity to improve specificity in reporting endovascular lower extremity interventions and adherence to accurate reimbursement practices. Practitioners should consult these updated codes along with modifiers 50 and 59 for bilateral and additional vessel procedures, respectively.

Keywords

SCAI

2026 CPT coding

lower extremity revascularization

iliac vascular territory

femoral popliteal vascular territory

angioplasty codes

stenting codes

lithotripsy codes

atherectomy codes

modifier 50 and 59