Question 1

What changed in the lower extremity revascularization codes for 2026?

Accepted Answer

On January 1, 2026 the AMA deleted CPT codes 37220 to 37235 and replaced them with 46 new codes, 37254 to 37299. They are organized into four territories, iliac, femoral and popliteal, tibial and peroneal, and inframalleolar, and by treatment and lesion type. A straightforward lesion is a stenosis and a complex lesion is a complete occlusion. Claims for 2026 dates of service that carry a deleted code will not be accepted, so charge masters, templates and superbills need the new codes.

Question 2

How do you tell a straightforward lesion from a complex one?

Accepted Answer

A stenosis, where some blood flow remains, is straightforward, and a complete occlusion, with no flow, is complex. The operative note or the angiogram report has to say which it was for each vessel treated, and if a vessel has both, the more complex lesion decides the level. A note that only says peripheral artery disease cannot be coded to the right level, so we ask the surgeon for an addendum before the claim goes out.

Question 3

How many vessels can be reported in each territory?

Accepted Answer

Each territory has an initial vessel code and add on codes for additional vessels. The iliac territory counts three vessels, the common, external and internal iliac, so up to two add on codes can follow. The femoral and popliteal territory counts two, the common femoral with the profunda as one and the superficial femoral with the popliteal as one, so one add on code can follow. The tibial and peroneal territory counts three and allows two add on codes, and the inframalleolar territory allows one. The tibioperoneal trunk and the pedal arch are not separate vessels unless they are the only vessel treated.

Question 4

How is intravascular lithotripsy billed?

Accepted Answer

Peripheral intravascular lithotripsy has two add on codes, +37262 for the iliac territory and +37279 for the femoral and popliteal territory. They are reported with the primary revascularization code for the same territory, once for each vessel treated, up to three times in the iliac territory and twice in the femoral and popliteal territory. For 2026 CMS assigned them work values of 3.0 and 4.0 RVUs. Coverage differs by payer, so we check the plan's policy before the case.

Question 5

Is diagnostic angiography billed separately with an intervention?

Accepted Answer

Not automatically. The revascularization and endograft codes include the imaging of the treated vessels and its interpretation, so a diagnostic angiogram done as part of the same intervention is bundled. CPT allows a separate diagnostic study when it is the first full study used to diagnose the problem and plan the treatment, or when a change in the patient's condition makes a new study necessary. Many payers expect modifier 59 or an X modifier such as XU on the diagnostic code, and a note that shows the reason. Common codes are 75625 for aortography, 75710 for one leg and 75716 for both legs.

Question 6

What is included in the new revascularization codes?

Accepted Answer

The 2026 codes include access, catheter placement, the intervention itself, the imaging guidance and the radiological supervision and interpretation needed to do it. Closure devices are not billed on top. Ultrasound guidance for access, 76937, is separate only when the note shows the vessel was patent and an image was saved. We apply these rules at charge entry so bundled services stay off the claim.

Question 7

What global period applies to vascular surgery procedures?

Accepted Answer

Open operations carry a 90 day global period, including bypass, carotid endarterectomy 35301, aneurysm repair and EVAR, where 34701 and 34705 are 90 day codes, and arteriovenous fistula creation such as 36821. Many catheter based services are 0 day services, including revascularization codes such as 37254 and 37263, vein ablation 36475 and the dialysis circuit codes 36901 to 36909. Visits around a 0 day service are not part of a global package, and a separate visit on the same day needs modifier 25. We look up the indicator for each code before billing.

Question 8

How is endovascular aneurysm repair (EVAR) billed?

Accepted Answer

Endovascular repair of the infrarenal aorta or an iliac artery is coded from the graft configuration and rupture status. Codes 34701 to 34708 cover aorto-aortic tube, aorto-uni-iliac, aorto-bi-iliac and ilio-iliac grafts, each with an unruptured and a ruptured version, and they include the graft deployment and the imaging. Extension prostheses outside the usual landing zones, fixation devices and access are add on lines. Fenestrated and branched repairs use 34841 to 34848, by the visceral vessels involved. The case opens a 90 day global period.

Question 9

Can access for EVAR be billed separately?

Accepted Answer

Often yes, when it is documented. Open femoral exposure for delivery of the endograft is reported with add on code +34812, percutaneous large sheath access with +34713 and open femoral exposure with a conduit with +34714. Iliac and brachial exposures have their own codes. The note has to say how access was gained on each side, and payers vary, so we ask for it at charge entry and check each plan's rule.

Question 10

How does Medicare cover carotid artery stenting now?

Accepted Answer

In its October 11, 2023 decision on NCD 20.7, CMS covers carotid stenting with an FDA approved stent and embolic protection device for symptomatic stenosis of 50 percent or more and asymptomatic stenosis of 70 percent or more, including standard risk patients. The decision added a requirement for shared decision making with the patient before the procedure and removed the old facility approval requirements, and it left other cases to the Medicare contractors. The codes are 37215 with distal embolic protection and 37216 without. Transcarotid cases are generally reported with 37215, and we confirm each payer's coding instruction.

Question 11

How is a carotid endarterectomy billed?

Accepted Answer

Report 35301 for a carotid endarterectomy, with or without a patch graft. It carries a 90 day global period, and a reoperation more than one month after the original operation adds +35390. The diagnosis is carotid stenosis, I65.2x with the side, and the symptom status belongs in the record because coverage rules depend on it. The carotid duplex before surgery, 93880 or 93882, is billed by the provider who reads it.

Question 12

What does Medicare require for varicose vein ablation?

Accepted Answer

Medicare contractors publish local coverage policies for varicose vein treatment, and commercial plans have their own. Common requirements are symptoms from the veins, a duplex ultrasound that shows reflux in the vein to be treated, a documented trial of conservative care such as compression, and a signed operative note. Thresholds such as reflux time, vein diameter and how long conservative care lasted differ by plan, so we load each payer's criteria before the case is scheduled. One pre procedure duplex can be billed, but the imaging done during the ablation is included.

Question 13

Which CPT codes are used for varicose vein treatment?

Accepted Answer

Endovenous ablation is coded by method: 36475 and 36476 for radiofrequency, 36478 and 36479 for laser, 36482 and 36483 for chemical adhesive and 36473 and 36474 for mechanochemical ablation, each as a first vein code and an add on for each additional vein in the same extremity. Sclerotherapy uses 36465 to 36471, stab phlebectomy uses 37765 for 10 to 20 incisions and 37766 for more than 20, and the duplex is 93970 or 93971. The ablation codes include the imaging guidance.

Question 14

Is spider vein treatment covered?

Accepted Answer

Injection of spider veins, telangiectasias of the limbs or trunk, is reported with 36468. Most plans treat it as cosmetic and do not cover it unless a specific policy says otherwise, so it is usually a patient responsibility with a signed financial notice. Treatment of symptomatic varicose veins and the truncal vein procedures are handled under the medical necessity rules described above.

Question 15

How do you bill dialysis access creation and maintenance?

Accepted Answer

Creating access is reported with 36821 for a direct fistula, 36818 to 36820 for a fistula with vein transposition, and 36825 or 36830 for a graft, and each carries a 90 day global period. Percutaneous fistula creation uses 36836 and 36837. Maintenance of an existing circuit is billed by the service with 36901 to 36906, plus add on codes 36907 to 36909 for the central dialysis segment, and each of those includes its own imaging. The diagnosis pairs end stage renal disease, N18.6, with dialysis dependence, Z99.2.

Question 16

How do you bill revascularization on both legs?

Accepted Answer

The new revascularization codes describe one limb. A two leg case is reported with the same codes on two lines, modifier RT on one and LT on the other, and each limb gets its own initial vessel code for each territory treated. Modifier 50 is meant for codes that describe a bilateral service, and payers differ in how they handle these lines, so we check each plan's rule before the claim goes out.

Question 17

What modifier do you use when a patient returns to the OR after a bypass for graft thrombosis?

Accepted Answer

Use modifier 78 on the code for the return procedure, such as 35875 or 35876 for thrombectomy of a bypass graft, when the same surgeon takes the patient back to the operating room for a related complication during the global period. Medicare pays only the intraoperative portion and does not start a new global period. Link a diagnosis that shows the complication and document why the return was unplanned. A planned second stage uses modifier 58, and an unrelated procedure uses 79.

Question 18

How do you bill a staged procedure, such as angioplasty followed by a bypass?

Accepted Answer

When the same surgeon plans a second procedure during the global period of the first, or the second is related and staged, append modifier 58 to the second procedure so it is paid and a new global period can start. The visit that decides on the operation is reported with modifier 57 when it falls on the day before or the day of a major procedure. A hybrid case that treats separate territories or sites is reviewed against the NCCI edits before both lines are billed.

Question 19

Which diagnosis codes support peripheral artery disease procedures?

Accepted Answer

Atherosclerosis of native arteries of the leg is coded in category I70.2 by symptom and side: I70.21 for intermittent claudication, I70.22 for rest pain, I70.23 and I70.24 for ulceration of the right and left leg, and I70.26 for gangrene. For a patient with diabetes, E11.51 and E11.52 describe diabetic peripheral angiopathy without and with gangrene, and a chronic ulcer adds an L97 code. The diagnosis has to match the operative note and the severity the payer's policy requires.

Question 20

What are Medicare's rules for supervised exercise therapy?

Accepted Answer

Since the national coverage decision effective May 25, 2017, Medicare covers supervised exercise therapy for symptomatic peripheral artery disease with intermittent claudication. Up to 36 sessions over 12 weeks are covered, each lasting 30 to 60 minutes, in a hospital outpatient setting or a physician's office, with qualified staff under the supervision of a physician, physician assistant or nurse practitioner. It is billed with 93668, and the contractor can cover more sessions when the record supports them, with the KX modifier as the attestation.

Question 21

How is abdominal aortic aneurysm screening billed?

Accepted Answer

Medicare covers a one time ultrasound screening for abdominal aortic aneurysm for eligible people, reported with G0389. It requires a referral from the treating provider, and eligibility rests on risk factors such as a family history of the aneurysm or a history of smoking in men aged 65 to 75. The screening is covered once, so the claim should check for an earlier screening before it is sent. Surveillance of a known aneurysm is billed with the duplex codes instead.

Question 22

How do you bill an assistant surgeon on a vascular case?

Accepted Answer

Report the surgical code with modifier 80 or 82 when a physician assists, or modifier AS when a physician assistant, nurse practitioner or clinical nurse specialist assists. Medicare pays 16 percent of the fee schedule amount for modifiers 80 and 82 and 85 percent of that amount for AS. Each code has an assistant at surgery indicator, and some codes need documented medical necessity or are not payable for an assistant, so we check the indicator and the payer policy first.

Question 23

What documentation supports modifier 22 on a vascular claim?

Accepted Answer

Modifier 22 needs a specific statement in the operative note that the work was substantially greater than usual and why, such as a hostile reoperative groin, heavy calcification that needed extra time or an unusually difficult exposure. Contractors look for increased time, intensity, technical difficulty or patient severity, written as a short separate paragraph. Vague wording does not support it. Send the statement with the claim, and use the modifier on surgical codes, never on an E/M visit.

Question 24

Why are lower extremity revascularization claims denied in 2026?

Accepted Answer

The most common causes are a deleted 2026 code carried over from an old template, an add on code without an initial code from the same territory, a note that does not say stenosis or occlusion, a diagnostic angiogram billed with the intervention without a reason, and a missing record of symptoms and conservative care for claudication. Each denial is read, corrected or appealed, then grouped by cause every month so the same one stops repeating.

Question 25

What changed in Medicare payment for vascular surgeons in 2026?

Accepted Answer

For 2026, CMS applied a negative 2.5 percent efficiency adjustment to the work values and intra service times of nearly all non time based services, including surgical procedures, and the One Big Beautiful Bill Act added a one year 2.5 percent increase to the conversion factor. The conversion factor is $33.4009 for most clinicians and $33.5675 for qualifying alternative payment model participants. Figures for 2027 are not final until CMS publishes its rule, and we update our fee schedules when each change takes effect.

Question 26

Do you handle prior authorization for planned vascular procedures?

Accepted Answer

Yes. Many commercial plans and their benefit managers require approval before elective endovascular revascularization, carotid stenting and vein ablation, and for claudication they often look for a trial of exercise and medical therapy. For plans covered by the federal prior authorization rule (CMS-0057-F), payers must decide within 72 hours for urgent requests and 7 calendar days for standard ones. We request approval when the case is booked and track it to a decision.

Question 27

Can a vascular surgeon bill a visit on the same day as a procedure?

Accepted Answer

Yes, when the visit is significant and separately identifiable. Add modifier 25 to the visit on the day of a 0 day procedure such as vein ablation or a dialysis circuit service. For a major operation with a 90 day global period, the visit that decides on surgery is billed with modifier 57 and a routine visit before it is included. The note has to show work beyond the usual pre procedure evaluation.

Question 28

Do vascular surgeons have to report MIPS?

Accepted Answer

Only if you are above the low volume threshold. For the 2026 performance year that means more than $90,000 in Medicare Part B allowed charges, more than 200 Part B patients and more than 200 covered services, and newly enrolled clinicians are excluded. Adjustments of up to plus or minus 9 percent apply two years after the performance year. Specialty registries can often report measures on your behalf, so check which options your society supports.

Question 29

How much does vascular surgery billing cost?

Accepted Answer

Most billing companies charge a percentage of the revenue they collect. Published vendor ranges commonly run from about 4 to 10 percent, and some offer flat monthly or per claim fees. The rate depends on claim volume, payer mix, how much work is included, such as coding, authorization and credentialing, and the state of your accounts receivable. We quote after reviewing your volume and payer mix.

Question 30

What do you need from us to get started?

Accepted Answer

EHR or practice management access, your payer list and fee schedules, your recent denial reports, and a list of surgeons and sites. We usually begin with an audit of revascularization and vein claims and open global periods, because that is where the fastest gains are.

Question 31

What should a vascular surgery practice look for in a billing company?

Accepted Answer

Look for coders who know the 2026 lower extremity revascularization rules, endovascular aneurysm repair, carotid and dialysis access billing, and which procedures carry a global period. Ask how add on lines are caught, how authorization for carotid stenting and vein ablation is handled, and how denials are reported. DrCareMSO builds each vascular claim from the operative note, vessel by vessel.

Question 32

How do vascular surgery billing services handle peripheral artery disease procedures?

Accepted Answer

Peripheral artery disease claims depend on the territory treated, the type of treatment, whether the lesion was a stenosis or an occlusion, and how many vessels were opened. We read those facts from the operative note, bill the first vessel and each add on line correctly, keep imaging and closure off the claim when they are included, and confirm coverage and medical necessity before the procedure.

Question 33

Do you bill for varicose vein and venous disease treatment?

Accepted Answer

Yes. We bill vein ablation, sclerotherapy, phlebectomy and venous stenting, and we check each plan's coverage policy for conservative treatment, ultrasound findings and symptoms before the procedure. Many payers deny vein treatment as cosmetic unless the record shows medical necessity, so we collect that documentation up front.

Question 34

How do you bill dialysis access creation and circuit procedures?

Accepted Answer

Fistula and graft creation carry a 90 day global period, while many catheter based circuit procedures do not. We code each service from the procedure note, include its imaging, link staged second procedures to the first, and pair the diagnosis with end stage renal disease and the access complication so the claim is supported.

Question 35

How do you reduce denials for vascular surgery claims?

Accepted Answer

We check coverage and approval before the case, build the claim from the completed procedure, apply the 2026 revascularization rules at charge entry, add the access and extension lines only with documentation, and correct rejections the same week. Monthly reports group remaining denials by cause so the source can be fixed.

Question 36

How do I choose a vascular surgery billing company?

Accepted Answer

Look for coders trained in vascular surgery claims, a plan for authorizations before the case or study, denial follow-up that continues until the claim is paid or appealed, and a monthly report you can read without a billing background. Ask who owns the payer deposits (they should go to your account) and ask to see a sample report before you sign.

Question 37

Is outsourcing billing a good fit for a small vascular surgery practice?

Accepted Answer

Often yes. A small practice carries the same payer rules as a large one, but with fewer staff to track revascularization, aneurysm, vein and dialysis access cases. Outsourcing replaces a part time billing hire with a team that works the claims every day. The right choice depends on your volume and how much time your staff spend on denials today, and we can look at your numbers with you on the first call.

Question 38

What reports will I receive from a vascular surgery billing company?

Accepted Answer

We send a monthly report that shows what was billed and paid, what is still open and why denials happened, grouped by cause so the source can be fixed. You can also ask for the payer mix and the oldest unpaid claims. Report details are agreed when you start, so you only get what you will use.

Vascular surgery medical billing, from endovascular repair to vein ablation

What does a vascular surgery billing company do?

Where vascular surgery claims lose money

The 2026 revascularization code change

Aortic repair with many moving parts

Imaging and access bundled into the procedure

Vein and dialysis work paid on proof

What we bill in every vascular surgery claim

Lower extremity revascularization (2026)

Aortic and iliac aneurysm repair

Carotid and cerebrovascular

Open bypass, endarterectomy and amputation

Dialysis access and central venous

Varicose veins and venous disease

Noninvasive testing and screening

Pick the vessel and see how the 2026 claim is built

How we run vascular surgery RCM

Verify coverage and approval rules

Capture the case at the source

Code to the 2026 rules

Apply the bundling edits

Submit, work denials and fix the cause

Why vascular surgery practices choose DrCareMSO

Certified coders for vascular surgery claims

Approvals before the case is scheduled

Every denial worked to payment

A monthly report in plain language

One vascular group, three leaks, fixed

Before

After

Vascular surgery billing questions

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