A vascular group bills its first iliac angioplasty of 2026 from a charge template that still carries last year’s codes. The line reads 37220, and the payer rejects it as an invalid code before a human reviewer ever opens the op note. A month of cases later, those rejections fill the AR report.
CPT code 37254 is the 2026 code for balloon angioplasty of a stenosis in the first iliac artery treated on one leg. It took over that work from deleted 37220 on January 1, 2026, as part of the new lower extremity revascularization CPT code set for 2026.
Getting 37254 paid comes down to four calls: the right sibling code, what the payment already bundles, how to report both legs, and op note wording that survives an audit. Our coders at One O Seven RCM work these iliac claims each week, and the same few errors keep coming back.
| Key TakeawaysCPT 37254 reports iliac angioplasty of a straightforward lesion (stenosis), initial vessel, one leg, effective January 1, 2026.Deleted 37220 split in two: 37254 for a stenosis and 37256 for a complete occlusion.A stent in the same iliac artery means 37258 or 37260, and 37254 comes off the claim.Medicare’s 2026 national rate for 37254 is $2,072.53 non-facility and $335.68 facility, on 7.30 work RVUs.The op note must state stenosis or occlusion, which iliac artery, the side, and that no stent went in. |
What Is CPT Code 37254?
CPT code 37254 reports endovascular angioplasty of a straightforward lesion, meaning a stenosis, in the first artery treated in the iliac vascular territory on one leg. It took effect January 1, 2026, and its payment covers access, selective catheterization, crossing the lesion, and the imaging needed to finish the angioplasty.
Your physician can reach the artery through an open or percutaneous approach. Either way, 37254 opens the new 46-code family that runs from 37254 to 37299, and your iliac code choice on a 2026 claim starts with it.
CPT 37254 Description in Plain English
The full 37254 CPT code description runs long. Broken into its four parts, it reads like this on a claim:
| Descriptor element | What it means on the claim |
|---|---|
| Iliac vascular territory, open or percutaneous | Common, external, or internal iliac artery; either access route |
| Transluminal angioplasty | Balloon dilation only, with no stent in that artery |
| Includes access, selective catheterization, crossing, imaging, and RS&I | You don’t bill those separately for the same artery |
| Unilateral; straightforward lesion; initial vessel | One leg, a stenosis, and the first iliac artery treated |
Source: AMA CPT 2026 code set, paraphrased.
Each part maps to one billing decision: which vessel, which lesion type, which leg, and whether a stent went in. Miss one and the claim belongs on a sibling code with a different rate. The ACC’s 2026 coding overview sums up the lesion rule: straightforward means stenosis, and complex means occlusion.
Which Arteries Count as the Iliac Vascular Territory?
Three arteries make up the iliac territory on each leg: the common iliac, the external iliac, and the internal iliac. On a given leg, the first of those arteries treated with a balloon alone for a stenosis takes 37254. A second iliac artery on that same leg moves to an add-on code instead.
Across the whole leg, the 2026 codes use four territories: iliac, femoral and popliteal, tibial and peroneal, and inframalleolar. Each territory carries its own initial-vessel codes. An iliac angioplasty and a superficial femoral angioplasty on the same leg end up as two separate initial-vessel lines.
[Image: Simple diagram of the iliac vascular territory with the common, external, and internal iliac arteries labeled. Alt text: Iliac vascular territory arteries for CPT 37254: common, external, and internal iliac]
What Replaced CPT 37220 in 2026?
The AMA deleted CPT 37220 on January 1, 2026, along with the other 15 codes from 37220 to 37235. Iliac angioplasty now goes to 37254 for a stenosis or CPT code 37256 for a complete occlusion, depending on what the physician documents about blood flow.
From inside one specialty, the scale of the change is easy to miss. The AMA’s CPT 2026 release counts 418 changes: 288 new codes, 46 revisions, and 84 deletions. We track the rest of the heart and vascular updates in our 2026 cardiology CPT code changes guide.
For vascular coders, the structure changed as much as the numbers did. The old family covered three territories with 16 codes. CPT codes 37254 to 37299 now cover four territories with 46.
The changes go well past the iliac arteries. Your list of deleted CPT codes for 2026 should also include CPT 37224 and the rest of the femoral, popliteal, and tibial codes from that old range. The new vascular CPT codes for 2026 replace all of them on the same date.
The 37220 to 37223 Crosswalk
SCAI’s 2026 lower extremity code guide maps each deleted iliac code, starting with the 37220 CPT code, to its two replacements:
| Deleted 2025 code | What it covered | 2026 replacement |
|---|---|---|
| 37220 | Iliac angioplasty, initial vessel | 37254 (stenosis) or 37256 (occlusion) |
| 37221 | Iliac stent, initial vessel | 37258 (stenosis) or 37260 (occlusion) |
| 37222 | Iliac angioplasty, additional vessel | +37255 (stenosis) or +37257 (occlusion) |
| 37223 | Iliac stent, additional vessel | +37259 (stenosis) or +37261 (occlusion) |
Source: SCAI 2026 LER code guide.
What CPT code replaced 37221? You now report iliac stenting with CPT code 37258 for a stenosis or CPT code 37260 for an occlusion.
Each old code split in two for one reason, and it drives the whole 2026 lower extremity revascularization CPT code set: lesion type now lives inside the code. Under CPT 37221, a stent was a stent. Your 2026 claim also has to tell the payer whether that stent treated a narrowed artery or one with no flow at all.
Date of Service Decides Which Code Goes on the Claim
A procedure performed on or before December 31, 2025 stays on CPT code 37220, even when you send a corrected claim or an appeal in 2026. Dates of service from January 1, 2026 forward must use the new 37254 to 37299 range, with no overlap period.
Keep 37220 in your charge master as an inactive code for 2025 dates, and block it at charge entry for anything dated 2026. A 2026 claim carrying 37220 usually comes back with CARC 181, procedure code invalid on the date of service, if the clearinghouse doesn’t reject it first.
| If your vascular charge templates date from before January, it’s worth checking them against the new codes. We can review your 2026 iliac claims and flag the lines still tied to 37220 to 37223. |
The Iliac Code Family: 37254 to 37262 at a Glance
The iliac territory has nine codes, the first block of CPT codes 37254 to 37299. CPT code 37254 is one of four initial-vessel codes, alongside 37256, 37258, and 37260. Four add-ons cover additional iliac arteries, and +37262 adds intravascular lithotripsy. Lesion type and stent use decide which one you report.
| Code | Treatment | Lesion | Vessel |
|---|---|---|---|
| 37254 | Angioplasty | Straightforward (stenosis) | Initial |
| +37255 | Angioplasty | Straightforward | Each additional |
| 37256 | Angioplasty | Complex (occlusion) | Initial |
| +37257 | Angioplasty | Complex | Each additional |
| 37258 | Stent, angioplasty included | Straightforward | Initial |
| +37259 | Stent | Straightforward | Each additional |
| 37260 | Stent | Complex | Initial |
| +37261 | Stent | Complex | Each additional |
| +37262 | Intravascular lithotripsy | Either | Add-on, up to three per leg |
Source: SCAI 2026 LER coding guidance.
Some coding sources online swap 37256 and 37258. The correct split: 37256 is the complex-lesion angioplasty code, and iliac stents use 37258 and 37260. CPT 37262 is the one add-on here that has nothing to do with an extra vessel; it pays for lithotripsy work on top of the main procedure.
37254 vs 37256: Is It a Stenosis or an Occlusion?
A straightforward lesion is a stenosis: the artery narrows, but some blood still gets through. Complex lesions are complete occlusions with no flow across them. The physician’s description of flow decides the code, and percent narrowing alone can’t move a case into the complex group.
Say the physician balloons a 90% stenosis of the right common iliac and places no stent. You’d report 37254-RT. CPT code 37256 would need the op note to describe a total occlusion, and “90% stenosis” says the opposite in plain words.
Auditors watch this pair because of the money. In 2026, CPT code 37256 pays $2,430.25 non-facility against $2,072.53 for 37254 under the national Medicare rate. A claim for 37256 on a note that reads “high-grade stenosis” hands an auditor an easy overpayment finding. It’s the first call our vascular and IR coding specialists check on iliac claims.
37254 vs 37258: What Changes When a Stent Goes In?
CPT code 37258 includes the angioplasty when your physician performs it in the same artery. Once a stent goes into that iliac artery, 37254 drops off the claim for that vessel. The 2026 hierarchy puts stent above angioplasty and complex above straightforward, and you report only the highest service per vessel.
The payment gap is wide. CPT code 37258 carries 8.75 work RVUs and pays $3,562.21 non-facility in 2026. Billing 37254 and 37258 together for one artery is unbundling, and payers deny the angioplasty line as a CO-97 bundling denial when they catch it.
When to Add CPT Code 37255 (and When Not To)
You’d add CPT code 37255 when the physician performs a straightforward angioplasty in a second, different iliac artery on the same leg. It’s an add-on, so it can’t stand alone on a claim. SCAI’s guidance allows up to two iliac add-ons per extremity, which covers all three iliac arteries on one side.
Add-on codes count additional vessels. Two lesions in the same common iliac still get one code, even when the physician treats them with separate balloon inflations. For 2026, +37255 carries 3.00 work RVUs, pays $510.03 non-facility and $135.94 facility, and has a ZZZ global, so it follows the primary code’s global period.
Codes People Confuse With CPT 37254
- 37246: Its descriptor excludes lower extremity arteries treated for occlusive disease, so it doesn’t work for iliac PAD.
- 0238T: Iliac atherectomy still uses this Category III code, since the iliac family has no atherectomy code.
- 37263: This is the femoral and popliteal angioplasty code for a straightforward lesion (stenosis); the occlusion code in that territory is 37265.
- 37264: It’s the femoral and popliteal add-on for an additional vessel with a straightforward lesion.
[Image: Three-question decision flow. Stent placed? Yes leads to 37258 or 37260. Occlusion? Yes leads to 37256, no leads to 37254. Another iliac artery on the same leg? Yes leads to +37255 or +37257. Alt text: Decision path for CPT code 37254 vs 37256 vs 37258 iliac claims]
What CPT Code 37254 Includes and What You Can Still Bill
The 37254 payment bundles the work needed to finish the angioplasty in that artery: access, selective catheterization, crossing the lesion, imaging guidance with supervision and interpretation, embolic protection, closure, and completion imaging. IVUS, lithotripsy, and qualifying diagnostic angiography can still go on the claim as separate lines.
Services Included in 37254
| Service | Separately billable with 37254? |
|---|---|
| Vascular access and selective catheter placement (same access) | No |
| Crossing the lesion | No |
| Imaging guidance and RS&I for the angioplasty | No |
| Embolic protection | No |
| Arteriotomy closure (pressure, device, or suture) | No |
| Completion imaging | No |
Source: CPT 2026 LER guidelines.
Some vascular charge templates add a selective catheterization code, such as 36246, or an angiography line to each case by default. With 37254 on the claim, the payment already covers catheterization through that same access. Payers that catch the extra lines deny them, and those NCCI edit denials cost you rework.
Services You Can Report Separately With CPT 37254
- IVUS: Report 37252 for the first vessel and 37253 for each additional vessel, when performed and documented.
- Intravascular lithotripsy: Add CPT 37262 in the iliac territory, up to three units per leg, per SCAI peripheral coding guidelines. It carries 3.00 work RVUs in 2026.
- Diagnostic angiography: Report it only with no prior study, an inadequate prior study, or a changed clinical condition, and only when this study led to the decision to treat.
- Thrombolysis: The CMS 2026 NCCI Policy Manual lets you report lower extremity thrombolysis with 37254 to 37299.
- Mechanical thrombectomy: It goes on its own line when the physician performs it.
- Extensive arterial repair: Codes such as 35226 can go on the claim when the work happens.
IVL has limits outside the iliac arteries. You can’t report +37262 in the tibial or inframalleolar territories, so check the territory before your coder adds an IVL line to a multi-level case.
Diagnostic angiography needs the most care of the group. Your op note should name which of the three conditions applied and say the study drove the treatment decision. Separate services like these are where vascular practices leave money behind, because charge templates often stop at the primary code.
How to Bill Bilateral Iliac Angioplasty With CPT Code 37254
CPT 37254 is unilateral, so you code each leg on its own findings. If both legs get the same initial-vessel code, append modifier 50 or report two lines with RT and LT, depending on the payer. Keep modifier 50 off the add-on codes.
Different findings on each leg change the picture. If the right side has a stenosis and the left has an occlusion, you’d bill 37254-RT and 37256-LT. Those are two different codes, so modifier 50 doesn’t fit, and RT and LT go on separate lines instead.
SCAI’s 2026 guidance spells out the rule: report each leg’s interventions on their own lines, and use modifier 50 only on bilateral initial-vessel codes. Putting modifier 50 on +37255 invites the CO-4 modifier denials that payers send when a modifier doesn’t fit the code.
Bilateral Claim Examples
| Scenario | How to code it |
|---|---|
| Stenosis in both common iliacs, balloon only | 37254-50, or 37254-RT and 37254-LT if the payer requires |
| Right stenosis, left occlusion | 37254-RT and 37256-LT |
| Right common and external iliac stenoses, left untreated | 37254-RT and +37255-RT |
| Second iliac artery treated on both legs | Initial code per leg, with each add-on listed by side using RT or LT, no modifier 50 |
Confirm the bilateral format with each payer before submission.
Medicare pays bilateral procedures at 150% of the single-side amount when the code’s bilateral surgery indicator is 1. Check the indicator for 37254 in the CMS fee schedule lookup before you build that math into a payment estimate. Our team checks payer-specific bilateral formats as part of vascular claim scrubbing before a claim goes out.
CPT 37254 Reimbursement in 2026
CPT code 37254 pays $2,072.53 in an office setting and $335.68 in a hospital or ASC under the 2026 Medicare Physician Fee Schedule, at the national non-QP conversion factor of $33.4009. The hospital or ASC receives its own facility payment on top of that.
Both figures are national amounts, before your locality’s geographic adjustment and before the patient’s 20% coinsurance. CMS set the 2026 values in the 2026 Medicare Physician Fee Schedule final rule, released October 31, 2025.
Physician Payment: Facility vs Non-Facility
| Code | Work RVU | Non-facility | Facility |
|---|---|---|---|
| 37254 | 7.30 | $2,072.53 | $335.68 |
| +37255 | 3.00 | $510.03 | $135.94 |
| 37256 | 10.75 | $2,430.25 | $492.00 |
| 37258 | 8.75 | $3,562.21 | $401.14 |
| +37262 | 3.00 | $3,409.23 | $135.94 |
Source: CMS CY 2026 Physician Fee Schedule, national amounts, non-QP conversion factor $33.4009.
The math behind each figure is total RVUs times the conversion factor. For 37254, the non-facility total is 62.05 RVUs: 7.30 work, 53.04 practice expense, and 1.71 malpractice. The facility total drops to 10.05 RVUs, because the hospital buys the balloon, wires, and catheters, and that’s why office-based labs see a six-to-one gap.
Clinicians who qualify as Advanced APM participants get the higher $33.5675 conversion factor in 2026. That puts 37254 at $2,082.86 non-facility and $337.35 facility. Both CPT 37254 and 37258 carry a 000 global period, while the add-ons carry ZZZ and ride on the primary code.
Hospital Outpatient and ASC Payment for 37254
The CY 2026 OPPS final rule assigns 37254 status indicator J1 and APC 5192. J1 marks a comprehensive APC: the hospital gets one payment, and most other outpatient services on that claim fold into it. Facility billers need that packaging logic built into charge capture, which is a core part of hospital revenue cycle management for vascular service lines.
CMS posts the national APC payment rate each quarter in Addendum B, on its CMS quarterly OPPS addenda page, and the October 2026 file is the current one. ASC rates for covered procedures sit in Addendum AA on the CMS ASC payment addenda page. Pull your rate from those CMS files each quarter.
The physician side works the same in both settings. Your surgeon bills the facility rate, $335.68 at the national level, with the place-of-service code that matches the setting. For hospital outpatient cases, our guide to POS 22 billing rules covers the details payers check.
How 37254 Compares With the Old 37220 Value
CMS valued 37220 at 7.90 work RVUs in 2025. Its replacement, 37254, carries 7.30 in 2026, a 7.6% drop of 0.60 RVU. Contracts that pay a percentage of Medicare reprice on their own, so that change flows straight through to your remits.
Commercial contracts need a closer look. A fee schedule keyed to 37220 may have no rate loaded for 37254 at all, and those lines come back as zero-pay or default-pay. Check each payer’s 2026 fee schedule load before the variance turns into months of underpayments.
| If your 2026 iliac payments are landing below these numbers after locality adjustment, the payer’s fee schedule load is the first place to look. A revenue cycle management team that reconciles each remittance against expected reimbursement catches that gap in the first batch. |
Documentation Requirements for CPT Code 37254
Documentation for an iliac angioplasty billed as 37254 must show five things: the lesion is a stenosis rather than an occlusion, which iliac artery the physician treated, the side, that the physician used a balloon with no stent, and the clinical indication that made the procedure medically necessary.
Auditors read the operative note first. If those five facts live only in the history and physical, your coder can’t defend the claim, so the op note itself has to carry them.
Stenosis vs Occlusion: The Words That Change the Code
| Operative note wording | Points to |
|---|---|
| “80% stenosis,” “high-grade stenosis,” “99% stenosis with antegrade flow” | 37254 (straightforward) |
| “Total occlusion,” “100% occluded,” “chronic total occlusion,” “no antegrade flow” | 37256 (complex) |
| “Subtotal occlusion,” “near occlusion” | Unclear; query the physician on whether any flow was present |
Lesion categories per CPT 2026: straightforward = stenosis, complex = occlusion.
A near-total stenosis is still a stenosis. Only a complete occlusion moves a lesion to 37256, however severe the narrowing looks. Coders shouldn’t pick the category from the angiogram images either. The physician’s written words set the code, and a query fixes vague wording before the claim goes out.
Medical Necessity: NCD 20.7 and Payer Criteria
Medicare covers PTA for atherosclerotic obstructive lesions in the lower extremities, and Medicare NCD 20.7 for PTA names the iliac, femoral, and popliteal arteries. Your chart still has to show why this patient needed the procedure on this date.
Plans that use Carelon set a tighter bar for claudication. The Carelon endovascular revascularization guideline requires all of these before it approves treatment:
- Significant lifestyle or work limitation from claudication, with no other condition limiting walking
- At least three months of structured exercise plus optimal medical therapy
- A target lesion in the aortoiliac or femoropopliteal vessels
Rest pain, ulceration, and gangrene follow separate criteria in that same guideline, so check the section that matches the patient’s diagnosis.
Payers also expect objective noninvasive testing in the chart. An ankle-brachial index study documents the pressure drop at the ankle, and our guide to ABI testing with 93922 covers how to bill it. For anatomic detail, an arterial duplex CPT 93925 study shows your physician where the narrowing sits before the case.
Criteria differ from plan to plan, so your front desk should confirm each plan’s rules before the case goes on the schedule. That check belongs in the same workflow as eligibility and prior authorization, weeks ahead of the procedure date.
ICD-10-CM Codes That Support CPT 37254
| Clinical picture | ICD-10-CM codes (FY2027) | Note |
|---|---|---|
| Claudication | I70.211 right leg, I70.212 left leg, I70.213 bilateral legs | Most common for elective iliac PTA |
| Rest pain | I70.221 right leg, I70.222 left leg, I70.223 bilateral legs | |
| Ulceration | I70.231 to I70.239 right leg, I70.241 to I70.249 left leg | Add an L97 code for ulcer site and severity |
| Gangrene | I70.261 right leg, I70.262 left leg, I70.263 bilateral legs | |
| Unspecified | I70.201 right leg, I70.202 left leg, I70.203 bilateral legs | Weak support when the chart documents symptoms |
Source: ICD-10-CM FY2027 code set, effective October 1, 2026.
Code the most severe stage documented for each leg. ICD-10-CM’s includes notes fold the milder stages into the higher codes, so rest pain with claudication goes to I70.22-, and you don’t add I70.21- beside it.
Watch for diagnoses that fight the procedure code. I70.92, chronic total occlusion of artery of the extremities, contradicts a stenosis code like 37254. I74.5 (embolism and thrombosis of iliac artery) and I77.1 (stricture of artery) describe non-atherosclerotic problems, so pairing either one with 37254 needs clear documentation.
When CPT Code 37254 Can’t Be Reported: Failed Lesion Crossing
If the wire can’t cross the iliac lesion, don’t report 37254, not even with modifier 52 or 53. CPT treats the case as diagnostic. You report the selective catheterization code for the highest-order vessel the catheter reached and the diagnostic angiography the physician performed and documented.
MedAxiom’s 2026 LER coding review quotes the CPT language on unsuccessful crossing and walks through a failed femoral case. On your claim, catheter order sets the first code. From the opposite groin, the common iliac is first order (36245) and the external iliac is second order (36246).
CPT code 36247 applies only if the catheter reached a third-order branch, such as the common femoral artery. Code from the catheter path in the note, even when the plan called for more. Unilateral extremity angiography is 75710, and in a hospital or ASC the physician appends modifier 26 professional component to that line.
The op note must also say the physician couldn’t cross the lesion and why, such as heavy calcification or a flush occlusion. That sentence tells a reviewer why a planned intervention ended up billed with diagnostic codes.
Common CPT Code 37254 Denials and How to Fix Them
Most iliac angioplasty denials in 2026 trace back to five errors: a deleted 2025 code on a 2026 date of service, a lesion type that contradicts the note, modifier 50 on an add-on, unbundled catheterization or imaging, and missing medical necessity support.
| CARC | What it means on a 37254 claim | Fix |
|---|---|---|
| CO-4 | Modifier 50 on an add-on, or 50 and RT/LT on the same line | Use modifier 50 on initial-vessel codes only, in the payer’s bilateral format |
| CO-11 diagnosis mismatch | Diagnosis contradicts the procedure, such as I70.92 with 37254 | Match the ICD-10 code to the documented lesion and side |
| CO-16 | Missing laterality or other required claim data | Add RT or LT and resubmit |
| CO-50 medical necessity | Payer says the chart doesn’t support necessity | Appeal with noninvasive studies and the conservative-therapy history |
| CO-97 | 37254 and 37258 billed for one artery, or a bundled catheterization line | Keep the highest service per vessel and drop the bundled line |
| CARC 181 | 37220 on a 2026 date, or 37254 on a 2025 date | Code by date of service |
| CO-197 authorization denials | No authorization on file | Check the plan’s retro-authorization rules, then appeal or rebill |
| CO-236 | NCCI code pair billed without a qualifying modifier | Add 59 or the matching X modifier only when the note supports a distinct service |
CARC definitions per X12; fixes based on CPT 2026 and NCCI rules.
The CO-236 row applies to a same-day diagnostic angiogram billed with 37254. SCAI’s 2026 guidance uses modifier 59 to mark separate, distinct procedures. On that angiogram line, the modifier holds up only when your op note shows one of the angiography conditions covered earlier.
The Noridian Office-Claim Issue for CPT 37254
Noridian JF Part B posted a notice on February 4, 2026: office-based claims for 37254 to 37299 had hit a claims processing error after the code change. The contractor ran mass adjustments from February 6 to February 20 and marked the issue resolved on February 23, 2026, per Noridian’s claims processing notice.
The notice told providers not to resubmit. Practices that sent those claims again risked CARC 18 duplicate denials on top of the original problem. Before your team reworks a batch of new-code denials, check your own Medicare contractor’s news page for a system issue.
Check the Current NCCI Quarter Before You Bill
CMS updates code-pair edits each quarter. The Q4 2026 PTP edits, version 32.3, took effect October 1, 2026, and CMS posted them on September 2. You’ll find the practitioner files on the CMS NCCI PTP edit files page.
Unit limits change on the same schedule. The Q4 2026 MUE files also took effect October 1, after CMS posted them on September 1. Run your 37254 pairs and units against the current quarter, since an edit that passed in July can fail in October.
| If 37254 denials are stacking up in AR, sort them by CARC before you appeal one at a time, because one root cause often sits behind most of them. That’s the first step our denial management services team takes with new vascular clients. |
2026 Peripheral Interventions Vascular Coding Worksheet for 37254 Claims
Run this pre-bill check on each 37254 CPT code claim before it leaves your system. Each item lines up with a CPT code 37254 denial covered above, and a fix at charge entry costs your team far less than an appeal.
- Charge master: Mark 37220 to 37235 inactive for dates of service from January 1, 2026, and keep 37254 to 37299 active.
- Template fields: Capture lesion type, iliac artery, side, stent yes or no, IVUS, and IVL units.
- Op note: Confirm the note states stenosis or occlusion in words and says whether the wire crossed.
- Code pick: Put stent above angioplasty and complex above straightforward, with one initial-vessel code per leg and no more than two iliac add-ons.
- Bilateral format: Use modifier 50 or RT and LT per payer, and keep modifier 50 off add-ons.
- Fee schedule indicators: Check the global period, bilateral and multiple-procedure indicators, and your locality rate in the CMS Physician Fee Schedule Search tool.
- Same-day visit: Bill a separate E/M only for a significant, separately identifiable service, with modifier 25 on procedure days attached.
Frequently Asked Questions About 37254 Billing
What CPT code replaced 37220 in 2026?
CPT code 37254 replaced CPT code 37220 for iliac angioplasty of a stenosis, and 37256 took over for a complete occlusion. Both codes took effect January 1, 2026, when the AMA retired the 37220 to 37235 range.
Date of service decides which set you use. A procedure on December 31, 2025 or earlier stays on 37220, even on a corrected claim filed in 2026, and anything later needs one of the new lower extremity codes.
What’s the difference between CPT 37254 and 37256?
CPT 37254 covers angioplasty of an iliac stenosis, and 37256 covers angioplasty of a complete iliac occlusion. Both are initial-vessel codes for one leg, and neither includes a stent in that artery.
Payment separates them: 37254 carries 7.30 work RVUs and $2,072.53 non-facility in 2026, against 10.75 RVUs and $2,430.25 for 37256. Your physician’s wording settles the choice, so a note that says “95% stenosis” supports 37254 even if the narrowing looks severe on the angiogram.
Can 37254 and 37258 be billed together?
You can’t bill 37254 and 37258 for the same iliac artery, because 37258 already includes the angioplasty. Each leg gets one initial-vessel code, so a stented common iliac plus a ballooned external iliac on that side goes out as 37258 plus +37255.
Opposite legs follow their own findings. A stented right side and a balloon-only left side can go out as 37258-RT and 37254-LT, in whatever laterality format the payer requires. That’s two initial-vessel codes, one per leg, which the rules allow.
Does CPT 37254 use modifier 50 or RT and LT?
CPT 37254 takes either one, depending on the payer, when both legs get the same initial-vessel code. Some payers want 37254-50 on a single line, and others want 37254-RT and 37254-LT on two lines. Check the payer manual first.
If the legs need different codes, such as 37254 on the right and 37256 on the left, modifier 50 doesn’t apply at all. Keep modifier 50 off add-on codes like +37255, since payers deny that pairing as a modifier conflict.
What does Medicare pay for 37254 in 2026?
CPT 37254 reimbursement under the 2026 Medicare Physician Fee Schedule is $2,072.53 non-facility and $335.68 facility, at the national non-QP conversion factor of $33.4009. Qualifying APM participants get $2,082.86 and $337.35.
Your actual payment shifts with your locality’s geographic adjustment, and the patient owes 20% coinsurance after the deductible. In a hospital outpatient department, the hospital bills its own facility claim under APC 5192, so two claims go out for one case: one from the hospital and one from the physician.
What is the global period for 37254?
CPT 37254 has a 000 global period, so Medicare counts no postoperative days after the procedure. The payment still covers the routine evaluation on the day of service.
A same-day E/M visit qualifies for its own payment only when the physician provides a significant, separately identifiable service and bills it with modifier 25. For a 000-day code, the decision to proceed with angioplasty doesn’t count as that service. Follow-up visits on later dates bill as regular E/M services.
Does CPT code 37254 need prior authorization?
Iliac angioplasty billed as 37254 needs prior authorization when the patient’s plan requires it, and plans differ. Traditional Medicare decides coverage under NCD 20.7. As of October 2026, CMS’s WISeR prior-authorization pilot, which runs in Texas and five other states, doesn’t list peripheral angioplasty among its services.
Many Medicare Advantage and commercial plans review peripheral revascularization through utilization managers such as Carelon. Check the patient’s plan before scheduling, and use our prior authorization guide to set up the workflow.
Is CPT 37263 an occlusion code?
No, CPT 37263 is the femoral and popliteal angioplasty code for a straightforward lesion, meaning a stenosis, in the initial vessel. The occlusion code in that territory is 37265.
One easy mix-up is reading 37263 as another iliac code. Both territories follow the same order: the stenosis code first, its add-on next, and the occlusion code after that. For the iliac arteries, that’s 37254 for a stenosis and 37256 for an occlusion. Check the territory before the lesion type.
Getting CPT Code 37254 Right on the First Submission
Three facts in the op note decide an iliac angioplasty claim: stenosis or occlusion, stent or no stent, and which leg. Your physician writes those down in plain words, your coder matches the code to them, and the denials in the table above have far less to work with.
The stakes add up claim by claim. Between 37254 and 37256, the 2026 national non-facility gap is $357.72 ($2,430.25 minus $2,072.53), and that’s what an auditor takes back each time a note says stenosis while the claim says occlusion.
| If you’d like a coder who works iliac claims each week to look at yours, contact our vascular billing team. |
