Policy No: 111
Originally Created: 03/01/2016
Last Reviewed: 01/01/2019
Last Revised: 01/01/2019
This policy applies to all physicians, other health care professionals, inpatient hospitals, outpatient hospitals and ASCs.
Placement of a catheter via the femoral artery into paired spinal arteries (intercostal above and lumbar below the diaphragm) with injection of contrast and imaging of the blood flow to the spine or spinal cord. This may also include injection of supreme intercostal, subclavian, thyrocervical, vertebral, internal iliac and median sacral arteries.
A group of vessels or arteries that are fed by a primary branch of the aorta or a primary branch of vessel punctured. A vascular family is divided into a primary branch, secondary branches and tertiary branches. Each primary branch with its secondary and tertiary branches would be a single vascular family. The primary branch would be the first order; the secondary branch would be the second order and the tertiary branch and beyond would be the third order.
The movement, manipulation or guidance of the catheter into a part of the arterial system beyond the aorta or the original vessel punctured.
Supervision and Interpretation (S/I)
The personal supervision of the performance of the radiologic portion of a procedure and the interpretation of the findings.
Our health plan considers arterial branches off the aorta as one vascular family. Per Medicare Benefit Policy Manual, diagnostic tests including spinal angiography are eligible for reimbursement when all the following are met:
- When supported by a referring physician's signed written order in the patient's medical record.
- When the attending or supervising physician is present during the procedure.
- When there is a documented signed procedure report by the supervising/attending physician in the patient's medical record.
Spinal angiography is not eligible for reimbursement when performed by an Interventional Radiology fellow without the presence of an attending physician.
Spinal angiography may be performed in the outpatient or inpatient hospital setting.
Current Procedural Terminology (CPT®) 75705 - Angiography, spinal, selective, radiological supervision and interpretation (S/I)
- Five (5) units of service for CPT 75705 are eligible for reimbursement for the entire procedure.
- S/I for each selective catheterization or vascular family is not separately reimbursable.
- Bypass modifiers are not allowed.
CPT 75774 - Angiography, selective, each additional vessel studied after basic examination, radiological
- Not eligible for separate reimbursement in addition to CPT 75705.
CPT 36215 - Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family.
- Two (2) units of service for CPT 36215 are eligible for reimbursement for the entire procedure.
CPT 36245 - Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family.
- Three (3) units of service for CPT 36245 are eligible for reimbursement for the entire procedure.
- Bypass modifiers are not allowed.
American College of Radiology. Diagnostic Radiology - General Practice Guidelines
Centers for Medicare & Medicaid Services (CMS), "Medicare Claims Processing Manual", Chapter 13 – Radiology Services and Other Diagnostic Procedures
CMS Medicare Benefit Policy Manual. Chapter 15 – Covered Medical and Other Health Services
Medicare Learning Network. MLN Matters. "Medically Unlikely Edits (MUE)"
American Medical Association. Current Procedural Terminology (CPT). Chicago: AMA Press. 2015.
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