CPT code 36247 – Third-order selective catheterization guide

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Key takeaways

CPT 36247 is the third-order or more selective catheterization code for the abdominal, pelvic and lower extremity vascular family

First order in that family is 36245 and second order is 36246. Thoracic and brachiocephalic vessels use 36215 through 36218

Report one unit per vascular family. Each additional second-order or higher vessel in the same family goes on add-on code 36248

CY2026 Medicare pays $260.15 in a facility and $1,362.84 in a non-facility setting at the $33.5675 conversion factor

Catheterizing a treated lower extremity artery is bundled into the new 37254 to 37299 revascularization codes

CPT code 36247: official descriptor and definition

The American Medical Association’s CPT code set gives 36247 this descriptor. Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family.

Two words in that descriptor decide most billing questions. The first, Initial, means one unit per vascular family. The second, Third order or more selective, means the code also covers fourth-order and deeper vessels, with no separate code for going further.

A vascular family starts at a named branch of the aorta and takes in every vessel that arises from it. Within one family you report only the highest order the catheter reached. So reaching a third-order vessel replaces 36245 and 36246 rather than adding to them.

How vessel order is counted

Order is counted outward from the aorta, one named vessel at a time. The first named vessel arising from the aorta is first order. From there, a vessel arising from that one is second order, and a vessel beyond that point is third order or more selective.

The common femoral artery is treated as the continuation of the external iliac, so it does not consume an order of its own.

Worked through on a typical contralateral lower extremity case, the count runs like this:

• Aorta: non-selective placement, reported with 36200
• Common iliac artery: first order, reported with 36245
• External or internal iliac artery: second order, reported with 36246
• Superficial femoral or profunda femoris artery: third order, reported with 36247
• Popliteal or tibial vessels beyond that point: still 36247, because the code covers third order and deeper

So the same count applies in the abdomen. Celiac axis is first order, common hepatic is second order, and the proper or right hepatic artery is third order. A uterine artery reached through the internal iliac is likewise third order, which is why uterine fibroid embolization access usually codes to 36247.

In short, both territories run on the same ladder. The table below sets them side by side, from the aorta outward.

Clinical indications and reporting specialties

CPT 36247 applies wherever the catheter has to travel two branch points past the aorta to reach the target vessel. Those cases are usually therapeutic rather than purely diagnostic. For example, common scenarios include uterine fibroid embolization, prostatic artery embolization, and hepatic chemoembolization or radioembolization. It also covers gastrointestinal bleed embolization and below-the-knee runoff studies from a contralateral groin puncture.

Billing for vascular procedures starts with knowing which specialties report each code. For 36247, the reporting specialties are:

• Interventional radiology: the most frequent reporter, during embolization, thrombolysis and selective diagnostic angiography
• Vascular surgery: during endovascular cases and combined open and endovascular procedures
• Interventional cardiology: during peripheral vascular studies and renal or visceral branch work
• Interventional nephrology: for selective renal branch access and dialysis access procedures

Every scenario needs documented medical necessity tied to a supporting ICD-10-CM diagnosis. Local Coverage Determinations from the Medicare Administrative Contractors set out which diagnoses support selective catheterization in each jurisdiction. So a claim submitted without an LCD-supported diagnosis is a routine medical necessity denial.

Medicare reimbursement for CPT 36247 in 2026

CY2026 payment for 36247 depends heavily on place of service. CMS publishes the Physician Fee Schedule each November for the year ahead. CY2026 is the first year with two conversion factors: $33.5675 for qualifying APM participants and $33.4009 for everyone else. So the figures below use the qualifying rate and carry no geographic adjustment.

Those locality figures come from applying each locality’s GPCIs to the published RVU components, using CMS Addendum E and the CY2026 relative value file. The spread is worth planning around. For example, an office-based lab in San Jose collects over $680 more per case than one in Arkansas, mostly because of the practice expense index.

Verify locality-specific rates with the CMS Physician Fee Schedule lookup tool before quoting reimbursement to physicians or coders. Also, electronic claim submission through Claim.MD adds eligibility checks that confirm coverage before the procedure is booked.

RVU breakdown behind the payment rates

Every CPT code carries three relative value components. Each one is adjusted by its own geographic practice cost index, added together, then multiplied by the conversion factor. The values below are the published CY2026 national figures for 36247.

Modifiers for CPT 36247

Modifier selection for 36247 decides whether a claim pays, bundles or draws an audit. The code has a 0-day global period, so an E/M service on the same day can be billed separately with modifier 25. The table below covers the modifiers used most often.

Bundling with lower extremity revascularization: CPT 2026 replaced the deleted 37220 to 37235 range, including 37226, with 37254 to 37299. Femoral and popliteal work sits in 37263 to 37279, and those codes bundle catheterizing the treated artery, so 36247 is not separately reportable there.

Embolization works differently. Codes 37241 to 37244 cover imaging supervision and completion angiography but not the catheterization, so 36247 stays separately reportable and often pairs with 37243.

Related and bundled codes

CPT 36247 sits inside a hierarchy, and mapping it correctly prevents both undercoding and overbilling. So the table below shows where each code in the family stops.

36245-36248 selective catheterization hierarchy

36215-36218: the thoracic and brachiocephalic series

Vessels above the diaphragm use a parallel series with the same order logic. Mixing the two ranges is a frequent coding error, so treat the territory as the first decision and the order as the second.

• 36215: each first order thoracic or brachiocephalic branch, such as the innominate or left common carotid
• 36216: initial second order thoracic or brachiocephalic branch, such as the right common carotid
• 36217: initial third order or more selective thoracic or brachiocephalic branch, such as the internal carotid
• 36218: add-on code for each additional second order or higher thoracic or brachiocephalic vessel

Several companion codes are reported alongside 36247. For example, they include 75710 for unilateral extremity angiography supervision and interpretation and 75716 for the bilateral version. Ultrasound guidance of vascular access is 76937, and embolization is 37242 or 37243. Each carries its own edits. Check current pairings against the AAPC CPT code lookup and the NCCI Policy Manual before billing them together.

ICD-10 diagnosis codes reported alongside the procedure

These are common pairings rather than a coverage list. Select the diagnosis that reflects the reason the procedure was performed, and confirm it against the applicable LCD. Also, codes with laterality or ulceration site axes need the full character string, not the truncated parent shown here. Our ICD-10-CM codes library carries each complete entry.

Documentation requirements in the operative note

The operative note is what proves the order level, and auditors read it closely. Four elements have to be on the page before a coder can support 36247 over a lower-order code.

• Access site and approach: name the puncture site and whether the approach was ipsilateral, contralateral or brachial
• Every named vessel in the path: record the sequence the catheter followed, not just the destination
• The vascular family reached: state it clearly, since it is what limits the number of units billable
• Clinical reason for selectivity: explain why the catheter had to go past second order, whether for embolization, thrombolysis or targeted imaging

A note that says only “catheter advanced into abdominal aortic branches” supports 36200 and no higher code. Instead, naming the vessels turns the same procedure into a defensible 36247 claim.

Common billing errors and denial reasons

CPT 36247 draws more denial letters than its volume suggests. The unit rules trip up billers who do not work in vascular coding every day. So solid medical billing compliance here comes down to matching the claim to what the note records.

• Billing a lower-order code as well: 36245 and 36246 describe stops on the way to a third-order vessel. Neither is separately payable in that family
• Reporting 36247 twice in one family: the descriptor says initial, so a second vessel in the same family goes on 36248 instead
• Confusing the territories: a carotid or subclavian branch belongs in 36215 to 36218, and coding it to 36247 is a straight denial
• Billing it with a treated lower extremity vessel: catheterization is bundled into the 37254 to 37299 revascularization codes for the artery being treated
• Place-of-service mismatch: the non-facility rate is more than five times the facility rate, so an incorrect place of service triggers a large overpayment recovery
• Omitting supervision and interpretation: 75710, 75716 and 75625 are reported separately when performed and documented

Many of these are catchable before a claim leaves the practice. Pabau routes claims through the Claim.MD clearinghouse, which validates place-of-service codes and modifier combinations ahead of transmission. Also, posting remittance advice promptly afterwards keeps appeals inside the timely filing window.

How Pabau supports vascular billing and coding

The operative note and the claim often live in separate systems. A coder reads a dictation that reached the chart hours later, queries the physician by email, and the claim sits unbilled while that thread runs. Instead, practice management software like Pabau keeps the note and the claim in one record. The person coding 36247 then reads the signed note itself.

• Structured procedure templates: vascular notes prompt for access site, each named vessel and the vascular family reached, so the order level is captured at signing
• Coding visibility at the point of billing: the claim is built beside the note it came from, which is where an order-level question gets settled
• Claim.MD integration: claims go out online with eligibility verification and ERA posting, using the data already on the record
• Denial reporting: procedure-level reporting shows which codes are being denied and why, without a separate analytics contract

Every Pabau subscription includes every feature, so a single-operator office-based lab and a hospital-affiliated group work from the same toolset. Pabau’s claims management software centralizes submission, tracking and remittance against the record the procedure was documented in. As a result, this shortens the distance between a finished case and a posted payment.

Keep vascular documentation and billing in one record

Pabau connects structured procedure notes to claim submission, so the coder reading a 36247 case sees the vessels the physician named. Clean claims then go out through our Claim.MD clearinghouse integration.

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Conclusion

CPT 36247 is the third-order or more selective code for the abdominal, pelvic and lower extremity vascular family. Every billing decision follows from that identity. Count the branch points, report one unit per family, and send additional vessels in the same family on 36248. Then check the territory, because every vessel above the diaphragm belongs to 36215 through 36218.

Place of service is the other decision worth money, at roughly $260 in a facility against roughly $1,363 outside one.

Pabau’s revenue cycle tools connect eligibility checks, claim submission and ERA posting in one workflow. In turn, that removes the manual handoffs that create errors on codes like this. To see how Pabau handles vascular and interventional billing for your practice, book a demo with the team.

Continue your research

Need to understand how clearinghouse claims submission works? Claim.MD clearinghouse integration covers how Pabau routes CPT claims to payers with real-time validation.

Managing denials on complex procedure codes? Denial codes in medical billing breaks down the CARC and RARC codes that appear on remittance advice for vascular procedures.

Want a structured billing compliance framework? Clean claim submission outlines what a clean-claim checklist covers for high-complexity interventional codes.

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