2025 CPT code 61635
(Active) Effective Date: N/A Revision Date: N/A Surgery - Endovascular Therapy Procedures on the Skull, Meninges, and Brain Surgery Feed
Transcatheter placement of intravascular stent(s), intracranial (e.g., atherosclerotic stenosis), including balloon angioplasty, if performed.
Modifiers may be applicable depending on circumstances.For example, modifier -59 (distinct procedural service) may be used if multiple stents are placed in separate vessels.Consult the CPT manual for specific modifier usage guidance.
Medical necessity for this procedure is established when the patient has symptomatic or asymptomatic intracranial arterial stenosis posing a significant risk of stroke.Documentation must support the presence of stenosis, its severity, and the patient's clinical presentation to justify the need for intervention.The procedure must be medically necessary according to the standards and guidelines of the payer.
The physician is responsible for pre-procedure patient assessment, selecting the appropriate access site for catheter insertion, advancing the catheter to the target artery under fluoroscopic guidance, performing balloon angioplasty (if needed), stent deployment, post-procedure hemostasis, and post-procedure patient monitoring.The physician may delegate certain tasks to other qualified healthcare professionals under their supervision, such as assisting with catheter insertion or monitoring.
In simple words: A thin tube (catheter) is inserted into an artery in the groin and guided to a narrowed artery in the brain. A tiny balloon may be inflated to widen the artery, and then a small, mesh tube (stent) is placed to keep it open. This helps improve blood flow to the brain and reduces the risk of stroke.
This procedure involves percutaneous insertion of a catheter into an artery (typically the femoral artery) to access the intracranial arteries. The catheter is advanced to the site of a stenotic, plaque-narrowed artery.Balloon angioplasty may be performed to dilate the narrowed artery, followed by placement of a self-expanding mesh stent to maintain arterial patency. The procedure includes selective vascular catheterization of the target vascular territory, diagnostic imaging (arteriography) of the target vascular territory, and related radiological supervision and interpretation.If angioplasty or stenting are not indicated, separate codes for catheterization and imaging should be reported.
Example 1: A 65-year-old male presents with acute ischemic stroke due to a significant stenosis in the left middle cerebral artery.A cerebral angiogram confirms the stenosis, and a transcatheter placement of an intracranial stent with balloon angioplasty is performed to restore blood flow., A 72-year-old female experiences recurrent transient ischemic attacks (TIAs) due to significant stenosis of the right internal carotid artery.A transcatheter intracranial stent is deployed to prevent future TIAs., An 80-year-old male with severe carotid artery stenosis undergoes a combined procedure: carotid endarterectomy and intracranial stenting to treat severe stenosis in both the internal carotid and middle cerebral arteries.Code 61635 would be reported for the intracranial portion of the procedure.
* Pre-operative assessment, including medical history, physical examination, and relevant imaging studies (e.g., CT angiogram, MRI angiogram).* Intraoperative documentation, including angiograms, images showing the placement of the stent, and any angioplasty performed.* Post-operative assessment, including neurological examination and any complications encountered.* Procedure notes accurately describing the location and number of stents deployed.
** This procedure is complex and requires specialized training and equipment. Always refer to the most up-to-date coding guidelines and payer policies for accurate billing.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: Refer to the CMS Physician Fee Schedule for current RVU values and payment rates. RVUs will vary based on facility type (non-facility vs. facility) and geographic location.
- Global Days: The global period for this procedure is not specified in the provided data.Refer to payer-specific guidelines for reimbursement policies regarding global periods.
- Payment Status: Active
- Modifier TC rule: No information provided on TC modifier applicability.Refer to payer-specific guidelines.
- Fee Schedule: Refer to historical CMS Physician Fee Schedule data for previous payment rates.
- Specialties:Neurology, Neurosurgery, Interventional Radiology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Hospital Outpatient