35266
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
15.43
Facility
$787.93
Non-Facility
$787.93
Documentation Required
- Providers must follow NCCI edits and Medicare coding guidelines and consult NCCI for correct code combinations prior to billing.
- When catheterization or exposure is performed by the same physician who performed the primary endovascular repair, append modifier -51 to the appropriate catheterization/exposure code on the claim.
- When endovascular repair is performed by cooperating physicians each should report the appropriate repair code and append modifier -62 (co-surgeons) or modifier -80 (assistant surgeon) as applicable.
- When reporting reduced services with modifier -52, submit supporting documentation or explanation with the claim.
Key Coverage Criteria
- Endovascular repair of an abdominal aortic and/or iliac artery aneurysm is covered when billed with CPT codes 34701-34708.
- Endovascular repair for acute aortic or iliac artery rupture (clinical and/or radiographic evidence of acute hemorrhage) is covered with CPT codes 34702, 34704, 34706, or 34708.
- Endovascular repair for contained/stable or chronic ruptures (pseudoaneurysms) is covered with CPT codes 34701, 34703, 34705, or 34707.
- Endovascular repair of descending thoracic aortic aneurysms or replacement is covered using appropriate thoracic CPT codes (e.g., 33880-33891) and associated catheter/imaging codes as applicable.
- Placement of an iliac branched endograft is covered: CPT 34717 (add-on) when reported with 34703/34704/34705/34706 (once per side) or CPT 34718 as a standalone code (use modifier -50 for bilateral 34718).
- Open arterial exposure required for endograft delivery in small-diameter vessels is covered and reported using the appropriate add-on exposure CPT codes (e.g., 34812, 34820, 34833, 34834, 34714, 34715, 34716).
1 Active Policy
A53124 — Billing and Coding: Endovascular Repair of Aortic and/or Iliac Aneurysms
J12
Related Codes
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