CPT code 37191 – IVC filter placement

Key takeaways

CPT code 37191 reports insertion of a vena cava filter, with vascular access, vessel selection, imaging guidance and radiological S&I included.

Repositioning (37192) and retrieval (37193) have their own codes, and IVUS (37252/37253) can’t be reported with 37191.

Coverage depends on a confirmed DVT or PE plus a documented reason anticoagulation can’t be used or has failed.

In 2026, Medicare pays about $191 in a facility and about $1,885 in an office, before geographic adjustment.

Pabau tracks prior authorization on the case and submits 837P claims through Claim.MD.

CPT code 37191 covers IVC filter insertion, imaging included

CPT code 37191 covers endovascular insertion of an intravascular vena cava filter, with the imaging included. Its official descriptor adds “vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed.”

The descriptor is maintained by the AMA’s CPT Editorial Panel within the Surgery / Cardiovascular System section. It has a 0-day (000) global period under the Medicare Physician Fee Schedule.

So one code pays for the whole placement. These are the facts to confirm before you code the case.

Every step of the placement sits inside the one code

The procedure starts with percutaneous venous access, most often through the femoral or jugular vein. The interventionalist guides a catheter to the vena cava and deploys the filter under live imaging. These components are all bundled into 37191:

• Vascular access, including venipuncture and sheath insertion
• Vessel selection and catheter navigation to the vena cava
• Fluoroscopic and ultrasound guidance
• Radiological supervision and interpretation (S&I)
• Intraprocedural roadmapping
• Filter deployment

Filters come in two clinical types. Permanent filters suit patients with a lifelong contraindication to anticoagulation, while retrievable filters give temporary protection. CPT code 37191 covers either type and doesn’t change with the filter’s brand or model.

Placement, repositioning and retrieval each have their own code

The 3719x family follows an IVC filter through its whole life, and each code describes a separate clinical event. Picking the wrong one is a common reason interventional radiology claims bounce.

Same-day billing of 37191 and 37193 depends on the payer. Some allow it with modifier -59 when a failed retrieval is followed straight away by a new filter. Others deny the pair outright, so check the payer’s policy before you send both codes.

Medical necessity hinges on why anticoagulation won’t work

Coverage for CPT code 37191 depends on matching the payer’s medical necessity criteria. Policies vary by MAC jurisdiction and plan, so treat these as the common covered indications rather than a universal rule.

• PE with a contraindication to anticoagulation: the patient can’t receive therapeutic anticoagulation because of documented bleeding risk or another contraindication.
• Recurrent PE despite adequate anticoagulation: documented therapeutic anticoagulation, followed by a confirmed repeat embolism.
• Proximal DVT with a barrier to anticoagulation: thrombus in the iliofemoral or femoral segment, with the barrier documented.
• High bleeding risk with acute VTE: patients who need urgent surgery or have active hemorrhage alongside a VTE.

On the claim, the diagnosis is what carries that story. A pulmonary embolism codes to I26, and an acute DVT of the leg often codes to I82.409 when the vein isn’t specified. Pair it with the code for the contraindication, such as a recent hemorrhage.

Not covered: prophylactic placement without a confirmed DVT or PE. Trauma teams sometimes request a filter for high-risk patients, but payers usually deny those claims without an active VTE diagnosis.

Commercial criteria tend to mirror Medicare’s, though some plans set stricter rules for retrievable filters. The CMS Physician Fee Schedule search tool is a good place to confirm how Medicare treats the code.

The operative note has to show six things

Thin operative notes are a leading cause of 37191 denials. A clean claim depends on these elements appearing in the record before anyone codes the case.

Before the procedure

• A confirmed diagnosis: DVT on venous duplex ultrasound or venogram, or PE on CT pulmonary angiography or V/Q scan.
• The specific contraindication to anticoagulation, stated in the physician’s note, such as intracranial hemorrhage or recurrent PE on therapy.
• A physician order that documents medical necessity.
• Signed patient consent that names the procedure.

In the operative note

• Access site (femoral vein, jugular vein or another approach)
• Filter type and brand deployed
• IVC diameter measurement confirming the filter size
• Imaging confirmation of filter position relative to the renal veins
• Final filter position (infrarenal is standard, so document a suprarenal site and its reason)
• Completion imaging result and any complications

A note that only says “IVC filter placed without complication” won’t survive payer review. Use medical billing compliance standards to build an operative note template that prompts for each element.

How a 37191 claim moves from procedure to payment

Most 37191 claims follow the same five steps. Each one has its own failure point, so it helps to know where the claim usually stalls.

1. Scheduling. Check whether the plan needs prior authorization, and record the auth number and dates. Emergent placements need the urgency documented instead.
2. Procedure and note. The physician documents the indication, the six operative elements and any moderate sedation time.
3. Coding. Report 37191 alone for the placement. Add 99152-99153 only when the proceduralist documents moderate sedation.
4. Setting check. Match the place of service to where the filter went in, because the facility and office rates differ about tenfold.
5. Submission and remittance. Send the 837P, then work the remittance. A denial goes back to step 2 or 3, rarely to the payer.

Only a handful of modifiers ever apply to 37191

37191 is a surgical code with no professional or technical split (PC/TC indicator 0), so -26 and -TC never apply. The modifiers you’ll actually use are few.

Laterality modifiers (-LT, -RT) don’t apply either. The vena cava is a single midline structure, so bilateral modifiers are never appropriate here.

Imaging, IVUS and venography are all bundled

Knowing what’s bundled prevents the most avoidable denials. CPT guidance treats imaging guidance as part of all three codes in the 37191-37193 family.

The AAPC Codify CPT lookup summarizes the NCCI edits for each code. Check it when a companion code looks like it might bundle into 37191.

2026 Medicare pays about $191 in a facility and $1,885 in an office

Medicare pays CPT code 37191 from the Medicare Physician Fee Schedule (MPFS), which CMS updates each year in its final rule.

The figures below are 2026 national values before geographic adjustment. Verify current rates in the CMS Physician Fee Schedule look-up before you quote payer contracts.

Work and malpractice are identical in both settings, so practice expense explains the whole difference in payment.

Use the FastRVU 2026 RVU lookup tool to apply the geographic adjustment for your MAC locality. Rates in Alaska, California and New York differ noticeably from national values.

In a hospital outpatient department, the facility side is paid under the Outpatient Prospective Payment System (OPPS), where the APC assignment sets the hospital’s payment. The physician still bills the facility rate. A medical claims clearinghouse checks the 837P data elements before the claim reaches the MAC.

Six denial patterns, and the fix for each

Most 37191 denials fall into six patterns, and each has a fix you can apply before submission. Track the ones you see with a denial management workflow, and decode payer reasons with this guide to medical billing denial codes.

Before you submit: A 37191 checklist

Run through this list on every claim. It takes a couple of minutes and catches the issues behind most of the denials above.

• The diagnosis code confirms DVT or PE, and a second code supports the contraindication.
• The physician note names why anticoagulation can’t be used or has failed.
• The operative note shows access site, filter type, IVC diameter, final position and completion imaging.
• No 77001, 76000, 75825, 37252 or 37253 sits on the same claim.
• No -26, -TC or laterality modifier is attached.
• The place of service matches the setting, so the facility or non-facility rate applies correctly.
• The prior authorization number is on the claim when the plan requires one.

Mistakes that turn a clean 37191 claim into a denial

A few errors come up again and again. Each one looks harmless at coding time.

• Reporting the imaging twice. Venacavography and IVUS feel like separate studies, but 37191 already pays for them.
• Copying a radiology habit. Adding -26 to a surgical code with no professional component gets the line rejected.
• Billing a prophylactic filter as routine. Without a confirmed VTE diagnosis, most payers treat it as not medically necessary.
• Quoting last year’s rate. RVUs and the conversion factor change every January, so refresh fee schedules annually.

CPT code 37191 and related codes at a glance

This table covers the codes you’re likely to meet on an IVC filter placement encounter, including the ones that can’t go on the same claim.

How Pabau keeps 37191 claims moving

Interventional practices often track authorizations in a spreadsheet and key claims by hand, then find a missing auth number only when the denial arrives.

Pabau, the practice management platform we build, keeps that work on the patient’s case instead. The prior authorization code, dates and sessions are tracked there, with a warning when one is missing. The CPT code attached to the service lands on the claim line, and the claim won’t send until required fields are complete.

In the US, Pabau’s streamlined claims management software submits 837P claims through Claim.MD, runs eligibility checks and posts ERA remittances. Your team sees each 37191 claim’s status without logging in to a separate portal.

Send IVC filter claims with the auth attached

Pabau tracks prior authorization on the patient’s case and submits 837P claims through Claim.MD, with eligibility checks and ERA posting. See how it fits interventional radiology and vascular practices.

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Conclusion

Most 37191 denials trace back to paperwork. The code itself is simple, because one line pays for access, imaging and deployment.

So put your effort into the record. Confirm the VTE diagnosis, name the contraindication, and keep IVUS and venacavography off the claim. Check the place of service too, since the office rate is nearly ten times the facility rate.

Book a demo to see how Pabau keeps the authorization on the case and sends your 37191 claims through Claim.MD.

Continue your research

Billing the hospital side of a filter placement? HCPCS code C1880 covers the vena cava filter device on the facility claim.

Want to understand how the claims lifecycle works end to end? Medical billing fundamentals covers the full workflow from superbill creation to payment posting.

Looking to cut rework on insurance claims? Claims management software from Pabau tracks authorizations and submits claims from the patient record.

Frequently asked questions