CPT code 37227 – Femoral/popliteal stent and atherectomy

Key takeaways

CPT code 37227 reported femoral/popliteal revascularization in one leg with stent placement and atherectomy, with angioplasty included when performed.

CPT deleted 37227 and the rest of 37220–37235 on January 1, 2026. For 2026 and later dates of service, report 37275 or 37277 instead.

Keep 37227 for claims, corrections, appeals, and audits with dates of service on or before December 31, 2025.

The femoral/popliteal territory counted as one vessel per leg, so 37227 was reported once per leg and never with 37224, 37225, or 37226.

The 2026 replacements split lesions into straightforward (stenosis) and complex (occlusion), so the operative note must now say which one was treated.

Practice management software like Pabau submits claims through its Claim.MD integration and tracks claim status, so a rejected deleted-code line surfaces quickly.

CPT code 37227: Official descriptor and status

CPT code 37227 is a deleted code for endovascular femoral/popliteal revascularization with stent placement and atherectomy in one leg. The American Medical Association publishes its official descriptor.

Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.

CPT deleted 37227 effective January 1, 2026. For 2026 and later dates of service, report 37275 for a straightforward lesion or 37277 for a complex lesion. Use 37227 only for services performed on or before December 31, 2025.

What replaced CPT 37227 in 2026

CPT deleted the whole 37220–37235 lower extremity revascularization family on January 1, 2026. It was replaced by 46 new codes, 37254–37299, grouped into four territories:

• Iliac: 37254–37262
• Femoral/popliteal: 37263–37279
• Tibial/peroneal: 37280–37295
• Inframalleolar, a new territory below the ankle: 37296–37299

The deletion covered lower extremity arteries only. Venous stent placement sits in a separate code family, and the initial vein is still reported with 37238.

The new codes add a second axis that 37227 never had. Each service is split by lesion type. The Society for Cardiovascular Angiography and Interventions (SCAI) defines a straightforward lesion as a stenosis and a complex lesion as an occlusion.

No single code takes over from 37227 automatically. Pick 37275 or 37277 from what the operative note says about the lesion in the initial vessel. If the note does not describe the lesion as a stenosis or an occlusion, query the physician before coding.

The 2026 family also allows a second femoral/popliteal vessel per leg. Add-on codes 37276 (straightforward) and 37278 (complex) report stent and atherectomy in an additional vessel. SCAI guidance limits the territory to one add-on code per leg.

Intravascular lithotripsy in this territory now has its own add-on code, 37279, which SCAI says can be reported up to twice per leg.

Put together, a femoral/popliteal stent-and-atherectomy claim turns on three questions, answered in the order shown below.

The 37224–37227 femoral/popliteal code family

Before 2026, 37224–37227 covered every endovascular treatment of the femoral/popliteal territory. The codes climbed in intensity, and you reported the single code that matched the most intensive service performed in that leg.

The other territories had their own codes. Iliac interventions used 37220–37223, and tibial/peroneal interventions used 37228–37231 as primary codes. Only the tibial/peroneal add-ons, 37232–37235, covered additional vessels, and none of them paired with 37227.

A patient could still receive codes from two territories in one session. For example, an iliac stent and a femoral/popliteal stent with atherectomy on the same leg were reported with a code from each family.

The one-code-per-leg rule for 37227

CPT treated the whole femoral/popliteal territory as a single vessel in each leg. That segment ran from the common femoral artery through the profunda femoris and superficial femoral arteries to the popliteal artery.

As a result, 37227 was reported once per leg, however many lesions were treated. If one SFA lesion was stented and a popliteal lesion had atherectomy with a stent, the leg still got one 37227.

If one lesion got only angioplasty and another got stent and atherectomy, 37227 still covered the leg. There was no femoral/popliteal add-on code before 2026.

What CPT 37227 includes and what is reported separately

CPT code 37227 bundled the work of opening the vessel in one femoral/popliteal territory. You could not bill these components as separate lines for that leg.

Included in 37227:

• Vessel access and selective catheterization of the target vessel
• Crossing the lesion with the wire and catheter
• All angioplasty, atherectomy, and stent placement in the territory
• Embolic protection, if used
• Imaging and radiological supervision and interpretation for the intervention
• Closure of the arteriotomy by any method

Reported separately, when documented:

• Diagnostic angiography, only when no adequate prior study exists, the patient’s condition has changed, or the prior study was inadequate
• Thrombolysis, mechanical thrombectomy, and embolization
• Interventions in the iliac or tibial/peroneal territories, using their own codes
• Treatment of the opposite leg

Separately reported diagnostic angiography usually needs modifier 59 and a clear note on why the study was needed. Check the NCCI edits for the date of service before submitting.

Pabau’s claims software for billers keeps these lines on one claim record, so the whole session is visible before the claim goes out.

Modifiers for CPT code 37227

Laterality modifiers were the most important ones on a 37227 claim. Modifier 59 or XS applied only in narrow cases.

For bilateral treatment, report each leg on its own line with RT or LT. Follow the payer’s policy on whether the second leg also needs modifier 59.

Documentation requirements for CPT code 37227

The operative note has to support both the stent and the atherectomy. If either one is missing, an auditor will downcode the leg to 37225 or 37226. For medical billing compliance, check that each pre-2026 note includes these elements:

• Leg and segments treated: Right or left, and which arteries (common femoral, profunda femoris, superficial femoral, or popliteal)
• Atherectomy: The technique (directional, rotational, orbital, or laser) and the device used
• Stent details: Type, diameter, length, and number of stents deployed
• Angioplasty: Balloon use, if performed, even though it adds no separate code
• Lesion findings: Percent stenosis before and after treatment, and the lesion’s length and location
• Access: The access vessel and the approach used
• Diagnostic angiography: Why a new study was needed, if it is billed separately

For 2026 dates of service, the note needs more. It must say whether each lesion was a stenosis or an occlusion. It must also say which femoral/popliteal vessel was treated, since the common femoral with profunda and the SFA with popliteal now count as separate vessels.

Build these fields into the procedure note template, so they are captured at the time of the procedure rather than chased after a denial.

Medicare reimbursement for CPT code 37227

Medicare paid 37227 under the Physician Fee Schedule, which changed every year. Look up the rate for the year of the date of service in the CMS Physician Fee Schedule lookup. The 2026 schedule prices 37275 and 37277, not 37227.

Pabau’s Claim.MD integration submits claims electronically, runs eligibility checks, and posts ERA remittances. That helps you spot underpaid or rejected vascular lines from the same dashboard.

Prior authorization for femoral/popliteal stent procedures

Prior authorization rules for 37227 were set by each payer and plan. When you appeal or audit a pre-2026 claim, pull the payer policy that was in force on the date of service.

Payers that require authorization usually look for proof of medical necessity. A typical packet includes:

• Ankle-brachial index (ABI) results
• Imaging, such as duplex ultrasound or CT angiography, showing the lesion’s location and severity
• A record of failed or unsuitable conservative therapy, such as supervised exercise or medication
• An ICD-10-CM diagnosis code for peripheral artery disease that supports the procedure

An authorization issued under 37227 late in 2025 may not cover a procedure performed in 2026. Confirm with the payer whether it must be reissued under 37275 or 37277.

Common 37227 claim denials and how to fix them

Most 37227 denials trace back to the seven causes below, and each one has a specific fix.

Look up each remark on the remittance in our denial codes guide. Then fix the root cause before resubmitting.

How Pabau supports vascular billing through the 2026 code change

Vascular practices now work two code sets at once. Claims for 2025 and earlier still carry 37227, while every new femoral/popliteal case needs a 2026 code. Keeping them apart by hand across spreadsheets and payer portals invites rejections.

Pabau, our practice management software, keeps the patient record, the procedure note, and the claim together. Through Claim.MD, it submits claims to payers, checks eligibility, tracks claim status, and posts ERA remittances.

As a result, a 37227 line billed for a 2026 date of service surfaces as a rejection on the claim itself. Your team can recode it from the note and resubmit it without switching systems.

Handle the 2026 vascular code change without lost claims

Pabau keeps claims, eligibility checks, and remittances in one place, so vascular practices can bill 37227 history and 2026 codes correctly.

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Conclusion

CPT code 37227 is now a historical code, but it still matters for every femoral/popliteal claim with a 2025 or earlier date of service. Those claims follow the old rule of one code per leg, with no lesion-type split.

From January 1, 2026, the same procedure is coded as 37275 or 37277, and a second vessel can take an add-on. Update your note templates and charge lists now so the two rule sets stay separate. To see how Pabau keeps vascular claims moving through the change, book a demo with our team.

Continue your research

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