CPT code 37229 – Tibial/peroneal atherectomy

Key takeaways

The AMA deleted CPT 37229 on January 1, 2026, so it is valid only for tibial or peroneal atherectomy with earlier dates of service.

For 2026 dates of service, report 37288 for a straightforward lesion (stenosis) or 37290 for a complex lesion (occlusion).

Angioplasty was never required for 37229. The code covered atherectomy and included same-vessel angioplasty only when it was performed.

Each additional tibial or peroneal vessel took an add-on code, such as 37233 for atherectomy, billed vessel by vessel rather than lesion by lesion.

Pabau, our practice management and billing platform, checks each claim for missing details before it goes out through the Claim.MD clearinghouse.

CPT code 37229 was deleted in 2026: use 37288 or 37290 instead

CPT code 37229 is a deleted code. It described endovascular atherectomy of the first tibial or peroneal artery treated in one leg. Angioplasty in that vessel was included when performed.

The AMA deleted it, along with the whole 37220–37235 lower extremity revascularization family, effective January 1, 2026. For dates of service from that day, the same procedure takes one of two new codes:

• 37288: atherectomy of a straightforward lesion (stenosis), initial tibial or peroneal vessel, angioplasty included when performed
• 37290: atherectomy of a complex lesion (occlusion), initial tibial or peroneal vessel, angioplasty included when performed

The replacement set runs from 37254 to 37299 and is organized by vascular territory, according to the SIR coding Q&A on the 2026 codes. Atherectomy in an additional tibial or peroneal vessel moves from add-on 37233 to 37289 or 37291, again split by lesion type.

Keep 37229 for one job only: claims, corrected claims and appeals for dates of service on or before December 31, 2025. Payers reject a 2026 date of service billed with 37229 as an invalid code.

Legacy CPT 37229 descriptor for claims dated before 2026

For claims dated before 2026, CPT code 37229, maintained by the American Medical Association, reads as follows. Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed.

Two phrases in that descriptor drive code selection. “Initial vessel” makes 37229 a base code, reported once per leg for the first tibial or peroneal artery treated. “When performed” makes angioplasty optional, so an atherectomy with no balloon inflation still coded as 37229.

The tibial/peroneal territory covers the anterior tibial, posterior tibial and peroneal arteries. The table shows what the code included and what was reported on top of it.

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

Each legacy tibial/peroneal code now splits in two, by lesion type. The crosswalk follows SCAI’s 2026 lower extremity revascularization guide, which maps 37229 to 37288 and 37290.

Under the 2026 rules, one initial-vessel code is reported per leg in this territory, with up to two add-on codes for additional vessels. The tibioperoneal trunk is not reported as a separate vessel unless it is the only vessel treated.

Femoral and popliteal work, legacy 37224–37227, has its own 2026 codes. It never shares a code with the tibial/peroneal territory.

How 37229 compared with the other tibial/peroneal codes

The legacy tibial/peroneal family had four initial-vessel codes, ranked by the most intensive service in the vessel. You reported one code per vessel, from the top of this hierarchy:

• 37228: angioplasty only
• 37229: atherectomy, with angioplasty included when performed
• 37230: stent placement, with angioplasty included when performed
• 37231: stent placement and atherectomy, with angioplasty included when performed

So 37229 was correct whenever atherectomy was the most intensive service in the first vessel and no stent went in. A stent in the same vessel moved the code to 37231. Balloon dilation with no atherectomy device was 37228.

One common error was treating 37225 as an atherectomy-only alternative to 37229. Code 37225 belongs to the femoral/popliteal territory, which ran from 37224 to 37227. It cannot describe work in a tibial or peroneal artery.

Add-on codes for additional tibial/peroneal vessels

CPT 37229 covered only the first tibial or peroneal vessel treated in the leg. Each additional vessel took an add-on code, chosen by the most intensive service in that vessel. Billing ran vessel by vessel, not lesion by lesion, so several lesions in one artery still counted as one vessel.

Add-on codes are reported only with a tibial/peroneal initial-vessel code for the same leg on the same claim. Each add-on lists the base codes it pairs with in its CPT parenthetical, so check the codebook for the date of service. Add-ons carry no global period of their own.

Modifiers for CPT code 37229

Modifier selection for CPT code 37229 affects both payment and claim edits. These modifiers apply most often.

Each lower extremity territory was coded separately: iliac (37220–37223), femoral/popliteal (37224–37227) and tibial/peroneal (37228–37235). Treating the superficial femoral artery and a tibial artery in one session gave one initial-vessel code in each territory.

Check the CMS NCCI edits for the date of service before adding a modifier. Append XS or 59 only when an edit applies and the operative note names the separate vessels.

Medicare reimbursement for CPT code 37229 claims

Medicare paid 37229 under the Medicare Physician Fee Schedule (MPFS) for dates of service before 2026. Because the code is deleted, take the payment amount from the fee schedule year that matches the date of service. The CMS Physician Fee Schedule look-up tool lets you choose the year.

Key payment points for 37229 claims:

• Facility vs. non-facility rates: the non-facility rate, paid in an office-based lab, was much higher than the facility rate. It covered the practice’s own device and overhead costs, while hospital outpatient and ASC claims took the facility rate.
• Global period: 37229 carried a 0-day global period under Medicare. An E/M service on the procedure date was bundled unless it was significant and separately identifiable, reported with modifier 25.
• Commercial payers: contracts often reference a percentage of the Medicare fee schedule. Confirm that your contract still lists a 37229 rate for 2025 dates of service.
• Medicare Advantage: plans often use Medicare rates as a floor but add their own authorization rules. Treat them like commercial payers for prior authorization.

Submitting through a clearinghouse catches formatting errors before the payer sees the claim. Pabau sends claims electronically through Claim.MD, as our Claim.MD clearinghouse guide explains. Tracking electronic remittance advice afterward shows whether a 2025-dated 37229 claim paid at the expected rate.

Prior authorization for tibial and peroneal atherectomy

Prior authorization rules for tibial and peroneal atherectomy vary by payer. Traditional Medicare has not required prior authorization for these procedures, but many Medicare Advantage and commercial plans do. Verify each payer’s policy before scheduling, because policies change at least annually.

For 2026 procedures, request authorization under 37288 or 37290, not 37229. An authorization on a deleted code may not match the claim that follows. Solid insurance eligibility verification before the procedure date prevents denials that are hard to rework on a 0-day global code.

Clinical criteria payers commonly ask for:

• Diagnosis of peripheral artery disease (PAD) with a recorded ankle-brachial index (ABI) or toe-brachial index (TBI), typically an ABI of 0.90 or below
• Imaging confirming significant tibial or peroneal stenosis or occlusion (duplex ultrasound, CTA or diagnostic angiography)
• For claudication, documented failure or contraindication of conservative treatment, such as supervised exercise therapy and medication
• For chronic limb-threatening ischemia (CLTI), rest pain, an active wound or gangrene, with confirming vascular imaging

Submit the request with the ICD-10-CM diagnosis, ABI or TBI values, the imaging summary and any wound care or medication history. Incomplete submissions are a frequent cause of authorization delays.

Documentation requirements to support CPT 37229 claims

Auditors reviewing 37229 claims look for specific elements in the pre-procedure workup and the operative note. A missing element can support a post-payment recovery demand.

• Pre-procedure workup: ABI or TBI values, plus duplex ultrasound or CTA/MRA confirming tibial or peroneal disease. Record the indication too: claudication after failed conservative therapy, rest pain or tissue loss
• Operative note, access and imaging: access site (femoral, tibial or pedal), catheter and guidewire position, and pre-intervention images of the lesion
• Operative note, atherectomy: device type (rotational, orbital, laser or directional), the named vessel and pre- and post-device images
• Operative note, angioplasty if performed: balloon size, inflation pressure and duration, the post-dilation result and confirmation that it was in the same vessel
• Lesion type: stenosis or occlusion, with the percent stenosis, which decides between 37288 and 37290 from 2026
• Post-procedure assessment: technical result, distal flow on the completion angiogram, closure method and disposition

Consistent documentation templates across the vascular team support medical billing compliance during payer audits. A note stating only that atherectomy and angioplasty were performed, with no vessel, device or result, will not survive an audit.

Common denial reasons for CPT code 37229 and how to prevent them

Denials on 37229 cluster around a few root causes. Most are preventable with checks before the claim is submitted.

Structured denial management workflows that sort 37229 denials by reason code expose patterns early. A spike in laterality denials after one operator starts dictating, for example, points to that operator’s note template.

For appeals on 2025 dates of service, keep 37229 on the claim. Recoding a 2025 procedure to 37288 or 37290 puts a code on the claim that did not exist on that date. Clean claim submission on the first pass depends on checking the code, diagnosis, modifier and authorization together.

ICD-10-CM diagnosis codes commonly paired with CPT 37229

Medical necessity for 37229 rests on a specific ICD-10-CM diagnosis. The I70.2- series, atherosclerosis of native arteries of the extremities, covers most cases. Laterality and severity both matter, and the unspecified code I70.209 rarely supports medical necessity alone.

Match the laterality of the ICD-10-CM code to the LT or RT modifier on 37229. A right-leg modifier paired with a left-leg diagnosis triggers a payer edit.

How claims management software keeps atherectomy claims on the right code

A code deletion hits a vascular practice at three points: the charge, the authorization and the claim. A 2025 procedure appealed in 2026 still needs 37229, while a new procedure needs 37288 or 37290. Mixing them up is easy when charges live in spreadsheets.

Pabau’s claims management software checks each claim for missing or invalid details, such as a missing authorization code, before it leaves the practice. In the US it also checks eligibility through Claim.MD before the visit.

It then tracks every claim from Pending to Paid, with remittances posted against it, so a rejected line is visible on the dashboard.

Keep atherectomy claims on the right code

Pabau’s claims management checks each claim for missing details before submission and tracks it through payment. Your team can review the code and authorization on every claim before it reaches the payer.

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Conclusion

Treat 37229 as a historical code. It still belongs on claims, corrected claims and appeals for 2025 dates of service, and nowhere else.

The bigger change sits in the operative note. Under the 2026 codes, a stenosis or an occlusion decides between 37288 and 37290. A practice that records the vessel, the lesion type and each device used will code the new series correctly the first time.

Book a demo to see how Pabau helps vascular practices catch missing claim details before claims reach the payer.

Continue your research

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