CPT code 37220 – Iliac artery angioplasty

Key takeaways

CPT code 37220 was deleted effective January 1, 2026, together with the rest of the 37220-37235 lower extremity revascularization family.

Iliac angioplasty of an initial vessel is now 37254 for a straightforward lesion (a stenosis) or 37256 for a complex lesion (an occlusion).

The 46 new codes still split by intervention type inside each territory, and lesion complexity is a second split layered on top of it.

If a stent goes into the same artery, bill 37258 or 37260 instead, because the iliac stent codes already include the angioplasty.

Claims billed with 37220 for a 2026 date of service are rejected, while procedures performed in 2025 keep the deleted code.

CPT code 37220 was deleted on January 1, 2026

CPT code 37220 is no longer valid for current claims. The American Medical Association (AMA) deleted it effective January 1, 2026, along with every other code from 37220 through 37235. None of those 16 codes appears in the CY2026 Medicare relative value files.

Through 2025, 37220 carried this official descriptor:

Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty.

That wording now applies only to procedures performed on or before December 31, 2025. For those cases it still belongs on the claim.

CPT 2026 replaced the family with 46 codes, numbered 37254 through 37299. The old family had three vascular territories, and the new one has four. The addition is an inframalleolar territory for the arteries of the foot.

Inside each territory, the codes still divide by intervention type, as the old family did. Each intervention type then splits by lesion complexity, and again by initial or additional vessel.

Each deleted iliac code therefore maps to a pair of successors, one for each lesion type. The crosswalk below follows the SCAI 2026 lower extremity revascularization code guide.

The stent half of that crosswalk has its own guide on our CPT code 37221 page.

The 2026 replacement codes for iliac angioplasty

Unilateral iliac angioplasty of the initial vessel is now reported with 37254 or 37256. The lesion described in the operative note decides which one.

The official descriptor for 37254 runs to four clauses:

• Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty,
• including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion,
• including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral;
• straightforward lesion, initial vessel.

37256 uses the same wording and ends with complex lesion, initial vessel instead. The full iliac range looks like this:

Read the table in two layers. The intervention type picks the group of codes, and the lesion type picks the code inside that group.

Four reporting rules from the SCAI 2026 guidance govern the iliac territory:

• Only 37254, 37256, 37258, or 37260 can describe the initial artery treated in a leg
• Up to two add-on codes may be reported for additional iliac vessels in the same leg
• When one vessel has several lesions, report a single code for the most complex service performed
• An additional lesion inside a vessel you have already coded never takes an add-on code

Choosing the right successor code for a former 37220 case

A procedure billed as 37220 in 2025 usually lands on 37254 or 37256 in 2026. Three questions, asked in order, settle the code, and the diagram after the list maps each answer to its code.

1. Was a stent placed in the same artery? If so, the angioplasty is bundled and the claim moves to 37258 or 37260.
2. Is the lesion a stenosis or an occlusion? A stenosis is straightforward and takes 37254. An occlusion is complex and takes 37256.
3. Were other iliac vessels treated on the same side? Add +37255 or +37257 for each one, up to two, based on that vessel’s own lesion.

Intravascular lithotripsy adds +37262 to whichever iliac primary code applies. Iliac atherectomy has no code in the new family, so it is still reported with Category III code 0238T.

CPT defines the two lesion types narrowly. A straightforward lesion is a stenosis, where some blood still flows through the segment. A complex lesion is an occlusion, with no flow through it. A severe, high-grade stenosis is still straightforward.

Here is how that plays out on a common case. The note describes a 90% stenosis of the right common iliac, treated with balloon angioplasty and no stent. That is 37254 with RT, not 37256.

What 37254 and 37256 include

The 2026 descriptors write the bundled services into the code text itself. Services on the list below cannot go on a separate line for the artery you treated.

Bundled imaging is the change most likely to break an existing charge template. Lines for angioplasty supervision and interpretation that used to ride along with 37220 will now reject.

Diagnostic angiography performed before the decision to treat follows separate rules. Payer policy on it varies, so check your MAC’s guidance before you edit your charge templates.

Clinical context: What iliac angioplasty involves

Coders reading operative reports need to recognize the steps behind an iliac angioplasty claim. A typical case runs in this order:

1. Access: A sheath is placed, usually in the common femoral artery, under ultrasound or fluoroscopic guidance.
2. Angiography: Contrast shows the iliac lesion and whether it is a stenosis or an occlusion.
3. Crossing: A guidewire is passed through the lesion, which can take specialty wires when the artery is occluded.
4. Balloon angioplasty: A balloon, which may be a drug-coated or cutting balloon, dilates the narrowed segment.
5. Completion imaging: Final angiography records residual stenosis and flow, and supports the decision not to stent.

The usual indication is atherosclerotic peripheral arterial disease (PAD) causing claudication or chronic limb-threatening ischemia. The diagnosis code has to match that documented indication, which the ICD-10 section below covers.

Modifiers for iliac angioplasty claims in 2026

Both 37254 and 37256 are unilateral codes. The CY2026 fee schedule gives them bilateral indicator 1, so modifier 50 applies when the same code is performed on both legs.

Billing bilateral iliac angioplasty

When both iliac systems are treated, code each leg on its own findings. One side can be a stenosis coded 37254 while the other is an occlusion coded 37256.

Two different codes go on separate lines with RT and LT. Modifier 50 fits only when both legs carry the same code. Confirm the format your payer or MAC expects before the claim goes out.

Medicare reimbursement for 37254 and 37256

CY2026 Medicare uses two conversion factors. Qualifying APM participants (QPs) are paid at $33.5675 per RVU, and all other clinicians at $33.4009.

The table multiplies the total RVUs in CMS’s October 2026 relative value file by each factor. The results are national rates before any geographic adjustment.

Against 37220 in 2025, the straightforward code lost ground and the complex code gained. Work RVUs fell from 7.90 to 7.30 for 37254 and rose to 10.75 for 37256.

In dollars, 37220 paid about $2,288 non-facility at the 2025 conversion factor of $32.3465. At the 2026 non-QP rate, a stenosis now pays about $2,073 and an occlusion about $2,430.

Your locality moves every figure in that table. Look up the rate that applies to you in the CMS Physician Fee Schedule Look-Up Tool.

Global period for 37254 and 37256

Both codes carry a 000 global period, the same as 37220 did. Guides that give this family a 90-day global are wrong.

A 000 global means no postoperative period follows the procedure. A documented follow-up visit on a later date is billed as its own service.

An evaluation and management visit on the procedure day is different. It needs modifier 25 and a significant, separately identifiable reason beyond the usual pre-procedure assessment.

Medicare coverage and prior authorization for iliac angioplasty

Medicare covers iliac angioplasty under National Coverage Determination 20.7, Percutaneous Transluminal Angioplasty. It covers PTA to treat atherosclerotic obstructive lesions in the iliac, femoral, and popliteal arteries.

To show medical necessity, the record usually needs these elements:

• An ankle-brachial index (ABI) or segmental pressures showing hemodynamically significant disease
• Imaging such as duplex ultrasound, CTA, MRA, or angiography that identifies the iliac lesion
• Symptom history, such as lifestyle-limiting claudication, rest pain, or tissue loss
• A record of conservative therapy tried, such as exercise therapy and medical management

Traditional Medicare does not generally require prior authorization for iliac angioplasty. Medicare Advantage plans and commercial payers often do, and each sets its own criteria. Check the requirement when the case is scheduled, not after it is performed.

Documentation requirements for iliac angioplasty claims

The operative report has to support the territory, the lesion type, the laterality, and the intervention on the claim. Most medical necessity and complexity denials trace back to a missing element from this list.

• Lesion character: Stenosis or occlusion, stated in plain words for each treated vessel
• Vessel and laterality: Common, external, or internal iliac, and which side, matching the RT or LT modifier
• Access: Percutaneous puncture site or open exposure, matching the open or percutaneous descriptor
• Pre-intervention imaging: Percentage stenosis or confirmation of occlusion, and the lesion location
• Balloon detail: Balloon type, diameter, length, and inflation pressure
• Result: Residual stenosis and flow on completion imaging
• Stent decision: A statement that no stent was placed, which supports an angioplasty code over a stent code
• Adjunct devices: Any lithotripsy or atherectomy, since each carries its own code
• Indication: The clinical reason, tied to a specific ICD-10-CM code

A coder who cannot find the lesion character has to query the physician before the charge is released. That delay is cheaper than a denial for unsupported complexity.

What to do with legacy 37220 claims

The code you report follows the date of service, not the date you send the claim. A procedure performed on or before December 31, 2025 stays on 37220 through corrected claims, appeals, and late submissions.

Only a 2026 date of service moves to the new codes. Three practical steps follow from that rule:

• Keep 37220 in your charge master as an inactive historical entry so older claims can still be worked
• Block 37220-37235 at charge entry for any encounter dated January 1, 2026 or later
• Review 2026 claims built from a 2025 template, since those are the ones most likely to carry a deleted code

AAPC’s Codify entry for 37220 carries the deleted-code flag. It is a quick status check when a payer questions an older line.

Common claim denial reasons for iliac angioplasty

Most denials on the new iliac codes come from a short list of causes. The table pairs each one with the step that prevents it.

ICD-10-CM diagnosis codes that support iliac angioplasty

The diagnosis must match the documented indication and meet the payer’s coverage criteria. Verify each code against the ICD-10-CM tabular list for the current fiscal year.

Our ICD-10-CM code library covers the individual codes in more detail. The table lists the pairings seen most often with iliac angioplasty.

Two pairings go wrong often. I70.92 never stands alone, because the tabular list tells you to code the underlying atherosclerosis first. A claudication symptom code should not replace I70.21- when the etiology is documented.

Where the report describes an embolus or thrombus rather than plaque, I74.5 is the diagnosis that carries the claim.

Moving vascular billing onto the 2026 codes

The 2026 restructure touches more than a code list. Charge templates, superbills, and operative note templates written for 37220 all need to change at once. Coders also have to read the lesion type first, because it now decides the code.

Practice management software like Pabau keeps those pieces in one system. Your team updates procedure codes, fees, and note templates once, and every new encounter uses the current version.

Claims go to payers through the Claim.MD clearinghouse integration, and electronic remittance advice comes back for posting. Rejections for a deleted code show up in the same workflow, so your team corrects and resubmits them while the case is still fresh.

Move your vascular billing onto the 2026 codes

Keep procedure codes, operative note templates, and Claim.MD claim submission in one system, so a CPT update is a change your team makes once.

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Conclusion

CPT 37220 is deleted, and it is valid only for procedures performed in 2025 or earlier. For a 2026 date of service, iliac angioplasty is 37254 for a stenosis and 37256 for an occlusion.

A stent in the same artery moves the claim to 37258 or 37260 instead. The choice between the two angioplasty codes also moves national non-facility payment by roughly $360.

Three changes carry most of the transition. Retire the deleted range from charge templates, add a lesion character field to the operative note, and remove the imaging lines the new codes absorb.

Pabau’s claims management software handles submission and remittance, so your team spends its time on coding rather than chasing claims. Book a demo to see it run a vascular billing workflow end to end.

Continue your research

Working a denied vascular claim? Denial management in healthcare shows how to triage, appeal, and stop the same denial recurring.

Want fewer rejections at first pass? What makes a clean claim covers the fields a payer checks before it pays.

Checking coverage before the procedure? Insurance eligibility verification explains what to confirm at scheduling.

Posting payments for vascular claims? Electronic remittance advice explains how 835 files map adjustments back to claim lines.

Want to see how the billing cycle connects? Revenue cycle management covers the path from charge capture to payment posting.

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