New Vascular CPT® Considerations for 2026

Today, we are continuing our January look at 2026 CPT code updates. As a reminder there were 5,933 new CPT codes with the January 1 update.

As with all updated sections it is crucial you read the new guidelines with this update and make sure your coding team is up to date. Updated lower extremity revascularization codes will be found in code range 37254-37299.

We did get some changes to lower extremity revascularization you will want to make sure you and your coding team are aware of. Prior to the 2026 update, CPT identified three arterial vascular territories, iliac, femoral/popliteal and tibial/peroneal. As of January 1, 2026, there are 4 vascular territories: Iliac, Femoral Popliteal, Tibial and Imframalleolar. The iliac territory includes the common iliac, external iliac and the internal iliac. You may see providers document hypogastric for the internal iliac, so watch for that in your documentation. The femoral popliteal territory includes the common femoral artery, the profunda artery, the superficial femoral artery and the popliteal artery. Included in the tibial territory are both the anterior and posterior tibial arteries as well as the peroneal artery. The newly identified imframalleolar territory includes both the dorsalis pedis artery and the plantar artery. With this change to the territory definitions, it is the perfect time for an anatomy refresher. Great chance to make this an educational opportunity for your coding team.

The revascularization services or technologies are still built on that progressive hierarchy where the lesser inclusive services are included in those more intensive services. With the January 2026 update there are
four technologies identified treating lower extremity lesions. Starting with the lowest in the hierarchy is angioplasty. This includes all methods except for intravascular lithotripsy at the highest end of the hierarchy. Next after angioplasty is stenting, all types are included such as bare metal, drug eluting, self- expanding or balloon expanding. Next is atherectomy such as laser, rotational or directional type to name a few. As previously noted, at the top of the lower extremity revascularization hierarchy is intravascular lithotripsy. As another educational opportunity I would encourage you to review videos or animations of the above procedures.

With the 2026 update we also got definition clarification of straightforward versus complex lower extremity lesions. CPT defines a straightforward lesion as one with stenosis less than 100%. This means a lesion with 99%
stenosis would be considered a straightforward lesion, regardless of how the provider documents the lesion. Codes should be assigned based on CPT definitions and guidelines. If there is even a trickle of flow, it would be
defined as a straightforward lesion. A complex lesion is defined as an occlusive lesion, occluded 100%. This means there is no flow at all past the lesion. Again, it is important to remember here that codes are to be
assigned based on CPT ® definitions, not provider statements on straightforward versus complex lesions.

As a final note here, in the event an intervention is not successful, only a code for the diagnostic catheterization and angiography of the vessel should be assigned. To treat a lesion, a wire must be passed through the
lesion and intervention performed. If this does not occur, only the diagnostic angiogram code should be assigned.