CPT code 37242 – Arterial embolization other than hemorrhage or tumor

Key takeaways

CPT Code 37242 reports arterial embolization or occlusion for reasons other than hemorrhage or tumor, such as AVMs, fistulas, aneurysms, and pseudoaneurysms.

Venous targets, including varicocele and pelvic congestion, go to 37241. Tumors and organ ischemia go to 37243, and hemorrhage goes to 37244.

Radiological supervision and interpretation, roadmapping, and imaging guidance are included, so 75710 and the deleted 75894 are not reported for that imaging.

Report 37242 once per operative field, not per vessel. A separate field treated in the same session takes modifier 59 or XS.

Selective catheter placement codes such as 36245-36248 remain separately reportable, subject to current NCCI edits.

CPT Code 37242: Official descriptor and procedure overview

CPT Code 37242 reports transcatheter embolization or occlusion of an artery when the goal is neither to stop bleeding nor to treat a tumor.

The American Medical Association’s CPT code set places it in the 37241-37244 vascular embolization and occlusion family.

The official descriptor has three parts:

• Vascular embolization or occlusion,
• inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention;
• arterial, other than hemorrhage or tumor (eg, congenital or acquired arterial malformations, arteriovenous malformations, arteriovenous fistulas, aneurysms, pseudoaneurysms)

The last part drives code selection. The target is arterial, the purpose is not hemorrhage control, and the target is not a tumor or an organ meant to become ischemic. If any of those fails, another code in the family applies.

Clinical indications: When to use CPT 37242

Use 37242 when the operative note documents an arterial lesion treated for its own sake. Common indications include:

• Arteriovenous malformations (AVMs): Malformations outside the central nervous system, such as limb, pelvic, or renal AVMs.
• Acquired arteriovenous fistulas: Post-traumatic and iatrogenic fistulas between an artery and a vein.
• Aneurysms: Visceral and peripheral artery aneurysms, such as splenic, renal, or iliac artery aneurysms.
• Pseudoaneurysms: Pseudoaneurysms treated electively, before they bleed.
• Other arterial malformations: Congenital or acquired arterial malformations named in the descriptor.

Intracranial and spinal cord targets fall outside this family and are reported with 61624. Uterine fibroid embolization treats a tumor, so it goes to 37243 even though the uterine arteries are embolized.

CPT 37242 vs. 37241, 37243, and 37244: Choosing the right code

The four codes share almost identical descriptor language. The target vessel and the clinical purpose decide which one applies.

Decision rule: Work through the operative note in this order.

1. Was the purpose to control hemorrhage or lymphatic extravasation? If yes, report 37244.
2. Was the target a tumor, or was the aim organ ischemia or infarction? If yes, report 37243.
3. Was the target a vein? If yes, report 37241.
4. Was the target an arterial lesion, such as an AVM, fistula, aneurysm, or pseudoaneurysm? If yes, report 37242.

Documentation requirements for CPT Code 37242

The operative note has to show why 37242 applies rather than another code in the family. Include these elements:

• Clinical indication: Name the lesion in terms that map to a specific ICD-10-CM code, such as “arteriovenous malformation of the left lower limb.”
• Purpose of the embolization: State that there was no active hemorrhage and that the target was not a tumor. This separates 37242 from 37243 and 37244.
• Target vessels and operative field: Name each vessel treated and the operative field it sits in, since the code is reported per field.
• Catheter selectivity: Record the vascular family and the order reached, from first order to third order or beyond. This drives the catheter placement code.
• Embolic agent and quantity: Document the specific agent, such as coils, particles, or a liquid agent, and the amount deployed.
• Angiographic findings: Record the pre-embolization anatomy and flow, then the post-embolization result, including residual flow and any complications.
• Physician attestation: The performing physician’s dated signature is required. An unsigned or undated note fails audit review.

Building a clean claim submission process means checking the procedure note template against this list before coding starts.

Catheter placement and imaging: What can be billed separately?

CPT 37242 includes radiological supervision and interpretation, intraprocedural roadmapping, and the imaging guidance needed to complete the intervention. Selective catheter placement is not part of the code, so it is reported separately.

Those catheter codes are subject to National Correct Coding Initiative (NCCI) procedure-to-procedure edits. Applying them correctly is one of the medical billing fundamentals for interventional procedures.

A separate diagnostic angiogram may still be reportable when the coding conditions are met, such as when no prior catheter-based study exists. Document why the study was needed and append modifier 59 or XS where the edit requires it.

The CMS NCCI Policy Manual explains which edit pairs allow a modifier and which never do.

Modifiers for CPT Code 37242

CPT 37242 is reported once per operative field, however many vessels in that field are occluded. RT and LT are not used to split one field into separate territories. These modifiers can apply:

• Modifier 59 or XS (distinct procedural service or separate structure): Use when a second, separate operative field is treated in the same session. It also applies when an NCCI edit pairs 37242 with a service that was distinct. Document the separate field or service.
• Modifier 51 (multiple procedures): May apply when 37242 is billed with another surgical procedure on the same date. Confirm each payer’s rules for multiple procedure reductions.
• Modifier 76 or 77 (repeat procedure): Use when the procedure is repeated on the same date for a documented reason, such as incomplete occlusion. Modifier 76 is the same physician, and 77 is another.

Medicare assigns 37242 a 0-day global period. A same-day E/M service needs modifier 25 and must be significant and separately identifiable from the usual preprocedure assessment. Visits on later days are not part of the global package.

Medicare reimbursement for CPT Code 37242

Medicare pays 37242 under the Medicare Physician Fee Schedule (MPFS), with separate facility and non-facility rates. Look up the current national and locality-adjusted amounts in the CMS Physician Fee Schedule lookup tool, since they change each January.

Facility rates apply when the procedure is done in a hospital outpatient department or an ambulatory surgery center. Non-facility rates apply in an office-based lab, where the physician carries the practice expense. Geographic practice cost indices (GPCIs) then adjust the payment for your locality.

Prior authorization and payer coverage policies

Prior authorization rules for arterial embolization vary by payer and by plan, and they change with annual policy updates. Confirm insurance eligibility and authorization status before scheduling, then check again before the claim goes out.

• Commercial payers: Many route vascular interventions through a utilization management program. Check each payer’s current policy for 37242 and the companion catheter codes.
• Medicare fee-for-service: Coverage depends on documented medical necessity. Check your Medicare Administrative Contractor (MAC) for any local coverage policy that applies.
• Medicare Advantage: Plans set their own prior authorization requirements, so verify with each plan before scheduling.
• Medicaid: Rules differ by state and by managed care plan.

A claim submitted without a required authorization is usually denied. Whether you can appeal, and on what grounds, depends on the payer and the plan contract.

Common denial reasons and how to avoid them

Understanding denial management workflows for 37242 starts with the reasons these claims fail. The most common are:

• Wrong code in the family: Billing 37242 for uterine fibroid or hepatic tumor embolization (37243), or for active bleeding (37244). The documented purpose decides the code, not the artery accessed.
• Venous targets billed as arterial: Varicocele and pelvic congestion embolization treat veins, so they are reported with 37241.
• Per-vessel billing: Reporting 37242 once per vessel, or with RT and LT for each territory, inside a single operative field. The code is reported once per field.
• Imaging billed on top: Reporting 75710 or the deleted 75894 for imaging that 37242 already includes.
• Missing authorization: Submitting without a required authorization, which payers often deny with CARC CO-197.
• Weak medical necessity: Notes without imaging evidence of the lesion. Keep the pre-procedure CT, MR, or ultrasound report in the chart for audit response.
• NCCI conflicts: Billing a bundled catheter or diagnostic code without the modifier and documentation the edit requires.

Review common denial codes in medical billing to map each CARC on the remittance advice to the correction needed before resubmission.

ICD-10 diagnosis codes commonly paired with CPT 37242

Diagnosis specificity drives medical necessity review. Choose the most specific site code the operative note supports. Common pairings include:

Payer coverage policies may list accepted diagnoses for embolization. Check your MAC’s local coverage determination (LCD) and each commercial policy before billing.

How Pabau keeps a 37242 claim clean from note to payment

Embolization claims fail when the procedure note, the code choice, and the claim drift apart. The note says “AVM”, the coder picks a code, and the payer finds the mismatch weeks later.

Practice management software like Pabau keeps notes, billing and claims in one place. The coder works from the signed note, so the target, purpose, and operative field stay attached to the charge.

When a claim is denied, the note and the claim history sit on the same patient record. Your team can see which detail was missing and correct the template as well as the claim.

Keep embolization claims tied to the note

Pabau keeps clinical notes, billing, and claims in one place, so your team codes from the signed record and corrects denials faster.

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Conclusion

Getting 37242 right comes down to two questions the note must answer: what was embolized, and why. An arterial lesion treated for its own sake is 37242. Bleeding, tumors, and veins each belong to another code.

Fix the procedure note template before you fix the claims. When the note names the target, the purpose, and the operative field, the code and the modifiers follow from it.

Pabau’s claims management software keeps those notes and claims together. Book a demo to see how it supports cleaner procedure billing for your practice.

Continue your research

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Want to understand the 837 file format used for electronic claim submission? 837 file billing guide covers the HIPAA transaction set used to submit professional claims to Medicare and commercial payers.

Looking for guidance on remittance advice and payment posting for 37242 encounters? Electronic remittance advice (ERA) guide explains how to read CARC and RARC reason codes on 835 files after claim adjudication.

Frequently asked questions about CPT Code 37242