CPT code 37228 – Tibial/peroneal angioplasty (deleted 2026)

Key takeaways

The AMA deleted CPT code 37228 on January 1, 2026, along with the rest of the 37220–37235 lower-extremity revascularization family.

For dates of service from January 1, 2026, report initial-vessel tibial or peroneal angioplasty with 37280 for a stenosis or 37282 for an occlusion.

Legacy 37228 covered angioplasty only, so atherectomy, stent placement and additional vessels each had their own legacy code.

The new codes are chosen by territory, intervention and lesion complexity. The operative note must state whether each lesion was a stenosis or an occlusion.

Keep 37228 for corrected claims and appeals with dates of service before 2026, using the descriptor that applied on that date.

CPT code 37228 was deleted in 2026: Use 37280 or 37282 instead

CPT code 37228 no longer exists for current claims. The American Medical Association deleted it effective January 1, 2026, together with the whole 37220–37235 lower-extremity revascularization family.

For a tibial or peroneal angioplasty of the initial vessel on or after that date, the replacement depends on the lesion. Report 37280 for a straightforward lesion and 37282 for a complex lesion. SCAI’s 2026 tibial/peroneal coding guide defines straightforward as a stenosis and complex as an occlusion.

The 16 deleted codes were replaced by 46 new codes, 37254–37299. They are organized by four vascular territories and by lesion complexity:

• Iliac: 37254–37262, including lithotripsy code 37262.
• Femoral/popliteal: 37263–37279, including lithotripsy code 37279.
• Tibial/peroneal: 37280–37295, the territory that legacy 37228 belonged to.
• Inframalleolar: 37296–37299, for the dorsalis pedis and plantar arteries.

Claims for procedures performed before January 1, 2026 still use 37228 and its legacy family. That matters for late charges, corrected claims and appeals.

Legacy CPT 37228 descriptor for claims dated before 2026

CPT code 37228 applied to dates of service through December 31, 2025. The AMA descriptor read: Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty.

The code described angioplasty only, in the first tibial or peroneal vessel treated on one leg. Any other intervention moved the claim to a different legacy code:

• 37229: initial vessel with atherectomy, including angioplasty within the same vessel when performed.
• 37230: initial vessel with stent placement, including angioplasty within the same vessel when performed.
• 37231: initial vessel with stent placement and atherectomy, including angioplasty within the same vessel when performed.
• 37232–37235: add-on codes for each additional tibial or peroneal vessel, by the same four intervention levels.

When you correct or appeal a 2025 claim, match the code to the most intensive service documented in that vessel. A note that documents atherectomy supports 37229 or 37231, never 37228.

Crosswalk: Legacy 37228–37235 to the 2026 tibial/peroneal codes

Each deleted tibial/peroneal code splits into two new codes, one for a straightforward lesion and one for a complex lesion. The crosswalk below follows SCAI’s 2026 LER code summary.

A plus sign marks an add-on code, which is reported with an initial-vessel code and never on its own. In the new series, the even-numbered codes 37280–37294 are initial-vessel codes and the odd-numbered codes 37281–37295 are add-ons. The grid below lays the series out by intervention and lesion type.

The 2026 descriptor for 37280 covers unilateral transluminal angioplasty in the tibial and peroneal vascular territory, open or percutaneous. It includes every maneuver needed to access and selectively catheterize the artery and cross the lesion.

It also includes the imaging guidance and radiological supervision and interpretation for the angioplasty within the same artery. Code 37282 carries the same wording but ends in “complex lesion, initial vessel” instead of “straightforward lesion, initial vessel.”

How to choose between 37280 and 37282, and when to add a vessel

Lesion complexity is the new decision point, and the operative note has to settle it. Under SCAI’s guidance, a stenosis is straightforward and an occlusion is complex. Then apply the territory rules:

• One primary code per territory: report one initial-vessel code for the tibial/peroneal territory on each leg.
• Most intensive service wins: code each vessel to the most extensive service performed in it, such as stent placement over angioplasty.
• Per vessel, not per lesion: a second lesion in the same artery does not earn an add-on code.
• Two add-ons at most: up to two add-on codes may be reported per leg for additional tibial or peroneal vessels.
• Tibioperoneal trunk: it is not reported as a separate vessel unless it is the only vessel treated.
• Stents: report the stent code once, even when more than one stent is placed in the same vessel.

Treating the femoral/popliteal segment in the same session is a separate territory, so it takes its own primary code from 37263–37279. A lesion that crosses territories and is treated with a single therapy is reported with one code.

What the 2026 tibial/peroneal codes include

The new descriptors fold access, catheterization and imaging into each code. Billing them separately on the treated vessel is a common unbundling denial.

ICD-10 codes that support tibial and peroneal angioplasty

Payers need a diagnosis that establishes medical necessity for the revascularization. Atherosclerosis of native arteries of the extremities, I70.2-, is the usual indication. Its fifth and sixth characters identify the presentation, the leg and, for ulcers, the site.

The diagnosis has to match the documented presentation. A note describing gangrene of the left foot belongs with I70.262, not with an ulceration or rest-pain code.

Modifiers for tibial and peroneal revascularization claims

Modifier choice depends on whether both legs were treated, or whether a separate procedure shares an NCCI edit with the revascularization code.

Documentation requirements for tibial and peroneal angioplasty

The operative report decides the code under the 2026 rules. Every element below should appear in the note to meet billing compliance requirements.

• Vessel treated: name the anterior tibial, posterior tibial or peroneal artery, and the leg.
• Lesion type: state whether each lesion was a stenosis or an occlusion, because that selects straightforward or complex.
• Crossing the lesion: confirm the lesion was crossed, since an uncrossed lesion is billed as diagnostic angiography.
• Access and catheter position: record the access site, approach and selective position in the tibial or peroneal artery.
• Intervention details: record balloon size and inflations, plus any stent or atherectomy device used.
• Angiographic findings: document pre-intervention stenosis or occlusion and post-intervention residual stenosis and runoff.
• Additional vessels: describe each extra vessel separately so every add-on code has its own support.

A note that says “tibial angioplasty performed” without the vessel or lesion type cannot support either 37280 or 37282.

Prior authorization for tibial and peroneal interventions

Many commercial and Medicare Advantage plans require prior authorization for elective lower-extremity revascularization. Plans had to reload their policies with the 2026 codes, so check that an approval names 37280–37295 rather than 37228. Run insurance eligibility verification before scheduling.

An authorization issued under 37228 for a 2026 date of service may not match the claim. Ask the plan to update it before the procedure, not after the denial.

Medicare reimbursement after the deletion of 37228

Medicare does not pay 37228 on a 2026 date of service, because the code is no longer valid. Payment for tibial and peroneal angioplasty now flows through 37280–37295, valued in the CMS Physician Fee Schedule lookup tool. Rates vary by locality and setting, so look up the current values for your MAC.

Common denial reasons for tibial angioplasty claims, and how to appeal

Most denials on these claims trace back to a handful of causes. Building a denial management workflow around them stops the same error from repeating.

• Deleted code on a 2026 claim: 37228 billed for a date of service on or after January 1, 2026 is returned as invalid. Resubmit with 37280 or 37282, matched to the documented lesion. The guide to medical billing denial codes lists the CARC codes involved.
• Complexity not documented: a complex-lesion code without a documented occlusion invites a downcode or a records request. Appeal with the angiographic findings that show the occlusion.
• Add-on code problems: an add-on billed without its initial-vessel code, or more than two per leg, is denied. Check the vessel count against the note before submitting.
• Imaging or catheterization unbundled: 76000, 75960–75964 or selective catheterization billed on the treated vessel will hit a bundling edit. Remove the line, because the 2026 codes already include it.
• Missing prior authorization: these denials are hard to overturn, so confirm the authorization lists the 2026 code before the case.
• Diagnosis mismatch: a diagnosis that understates the documented severity triggers a medical necessity review. Appeal with the note and imaging that confirm the presentation.

For legacy 37228 claims with 2025 dates of service, the usual fix is the intervention level. If the note documents atherectomy or a stent, correct the claim to 37229, 37230 or 37231.

How claims management software keeps tibial angioplasty claims on the 2026 codes

A code deletion hits a vascular practice in three places at once: the charge, the authorization and the claim. Practices that bill from spreadsheets or a separate billing service often find out from the first wave of denials.

Pabau, the practice management and billing platform we build, runs validation checks before a claim leaves the practice. Its claims management software confirms that required details, such as authorization codes and member numbers, are present. It also runs real-time eligibility checks through Claim.MD.

Each claim then moves through one status dashboard, from submitted to paid, with remittances posted against it. Pair that with a clean claim checklist, and your team corrects a 37228 charge before it turns into an appeal.

Keep vascular claims on the 2026 codes

Pabau’s claims management checks each claim for missing details before submission and tracks its status through payment. Your team catches a deleted code or a missing authorization before the payer does.

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Conclusion

Treat 37228 as a historical code. It still matters for 2025 dates of service, corrected claims and appeals, and it should appear nowhere else.

The larger change is in the operative note. Under the 2026 codes, the difference between a stenosis and an occlusion moves the claim between 37280 and 37282. A practice that captures lesion type, vessel and crossing in every note will code the new series correctly the first time.

Book a demo to see how Pabau helps vascular practices catch coding and authorization errors before claims reach the payer.

Continue your research

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Tracking authorization status across a high-volume vascular caseload? Revenue cycle management guide explains how integrated RCM workflows reduce prior auth and denial management overhead.

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