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2025 CPT code 37231

Initial revascularization of a unilateral tibial or peroneal artery using an endovascular, open, or percutaneous approach, with stent placement(s) and atherectomy; includes angioplasty if performed.

Consult the most recent CPT codebook and guidelines for detailed coding instructions. Specific instructions for selective catheterizations apply if multiple vessels are treated.

Modifiers may be applicable depending on the circumstances of the procedure.For example, modifier 51 (multiple procedures) might be used if multiple procedures were performed on the same day, and modifiers 22, 59, etc. may also be necessary.

Medical necessity is established by the presence of significant arterial stenosis causing symptoms such as claudication, rest pain, or critical limb ischemia.Appropriate pre-operative imaging (e.g., angiography) should demonstrate the stenosis, and documentation should clearly link the procedure to the patient’s symptoms and justify the intervention.

The physician's responsibilities include selecting the appropriate approach (endovascular, open, or percutaneous), performing the arterial access, deploying the stent(s), performing atherectomy, and confirming successful revascularization via angiography.The physician may delegate certain aspects of the procedure to other qualified personnel under their supervision.

IMPORTANT:37228 (transluminal angioplasty only), 37229 (atherectomy only), 37232 (additional tibial/peroneal artery with angioplasty), 37233 (additional tibial/peroneal artery with atherectomy), 37234 (additional tibial/peroneal artery with stent placement), 37235 (additional tibial/peroneal artery with atherectomy and stent placement)

In simple words: This code covers a procedure to restore blood flow in a blocked or narrowed artery in one leg.The doctor might use a minimally invasive approach (through the skin) or open surgery.A stent (a small tube) is placed to keep the artery open, and plaque (buildup inside the artery) is removed.If needed, another procedure to widen the artery is also included.

This code encompasses the initial revascularization of a single tibial or peroneal artery in one leg.The procedure can be performed via an endovascular, open, or percutaneous approach.It includes transluminal stent placement(s) and atherectomy to restore blood flow.Angioplasty is included if performed within the same vessel.

Example 1: A 70-year-old male presents with critical limb ischemia in his left leg due to a severely stenosed superficial femoral artery.The physician performs a percutaneous transluminal angioplasty (PTA) with stent placement and atherectomy of the left superficial femoral artery.Code 37231 is reported., A 65-year-old female with peripheral artery disease undergoes an open surgical procedure to revascularize her right tibial artery.The surgeon performs an arteriotomy, atherectomy, and places a stent. Code 37231 is reported., A 55-year-old male with diabetes and peripheral artery disease presents with claudication.A percutaneous approach is used to access the right peroneal artery.Atherectomy and stent placement are performed to improve blood flow. Code 37231 is used.

Detailed operative report including approach (endovascular, open, percutaneous), artery treated, stent type and number, length of stents, atherectomy technique used, angiographic images pre- and post-procedure demonstrating successful revascularization, and patient’s clinical presentation supporting the medical necessity of the procedure.Pre-operative and post-operative assessments should also be documented.

** The description mentions that this code applies to the *initial* vessel treated. If additional tibial or peroneal arteries are treated during the same encounter, separate codes (37232-37235) should be used.

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