DRAFT LCD Reference Article Billing and Coding Article

Billing and Coding: Non-Invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

DA60315

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
Novitas Solutions, Inc.	A and B MAC	04111 - MAC A	J - H	Colorado
Novitas Solutions, Inc.	A and B MAC	04112 - MAC B	J - H	Colorado
Novitas Solutions, Inc.	A and B MAC	04211 - MAC A	J - H	New Mexico
Novitas Solutions, Inc.	A and B MAC	04212 - MAC B	J - H	New Mexico
Novitas Solutions, Inc.	A and B MAC	04311 - MAC A	J - H	Oklahoma
Novitas Solutions, Inc.	A and B MAC	04312 - MAC B	J - H	Oklahoma
Novitas Solutions, Inc.	A and B MAC	04411 - MAC A	J - H	Texas
Novitas Solutions, Inc.	A and B MAC	04412 - MAC B	J - H	Texas
Novitas Solutions, Inc.	A and B MAC	04911 - MAC A	J - H	Colorado New Mexico Oklahoma Texas
Novitas Solutions, Inc.	A and B MAC	07101 - MAC A	J - H	Arkansas
Novitas Solutions, Inc.	A and B MAC	07102 - MAC B	J - H	Arkansas
Novitas Solutions, Inc.	A and B MAC	07201 - MAC A	J - H	Louisiana
Novitas Solutions, Inc.	A and B MAC	07202 - MAC B	J - H	Louisiana
Novitas Solutions, Inc.	A and B MAC	07301 - MAC A	J - H	Mississippi
Novitas Solutions, Inc.	A and B MAC	07302 - MAC B	J - H	Mississippi
Novitas Solutions, Inc.	A and B MAC	12101 - MAC A	J - L	Delaware
Novitas Solutions, Inc.	A and B MAC	12102 - MAC B	J - L	Delaware
Novitas Solutions, Inc.	A and B MAC	12201 - MAC A	J - L	District of Columbia
Novitas Solutions, Inc.	A and B MAC	12202 - MAC B	J - L	District of Columbia
Novitas Solutions, Inc.	A and B MAC	12301 - MAC A	J - L	Maryland
Novitas Solutions, Inc.	A and B MAC	12302 - MAC B	J - L	Maryland
Novitas Solutions, Inc.	A and B MAC	12401 - MAC A	J - L	New Jersey
Novitas Solutions, Inc.	A and B MAC	12402 - MAC B	J - L	New Jersey
Novitas Solutions, Inc.	A and B MAC	12501 - MAC A	J - L	Pennsylvania
Novitas Solutions, Inc.	A and B MAC	12502 - MAC B	J - L	Pennsylvania
Novitas Solutions, Inc.	A and B MAC	12901 - MAC A	J - L	Delaware District of Columbia Maryland New Jersey Pennsylvania

Draft Article Information

General Information

Source Article ID
N/A

Draft Article ID
DA60315

Draft Article Title
Billing and Coding: Non-Invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

Article Type
Billing and Coding

CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association.

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CMS National Coverage Policy

Internet-Only Manuals (IOMs)

CMS IOM Publication 100-04, Medicare Claims Processing Manual,

Chapter 4, Section 20.6.6 Modifiers for Radiology Services
Chapter 13, Section 10 ICD Coding for Diagnostic Tests

Social Security Act (Title XVIII) Standard References:

Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Proposed Local Coverage Determination (LCD) DL40276, Non-Invasive Arterial Duplex of the Upper and Lower Extremities. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Arterial duplex scans (CPT codes 93925, 93926, 93930, and 93931) cannot be billed with venous duplex scans (CPT codes 93970 and 93971) on the same date of service.

Arterial duplex scans of the lower extremities (CPT codes 93925 and 93926) cannot be billed with arterial duplex scans of the upper extremities (CPT codes 93930 and 93931) on the same date of service.

The following coding guidance is consistent with the CPT manual coding directive:

In reference to the same extremity(ies), do not report CPT code 93925 with CPT code 93985; or CPT code 93926 with CPT code 93986; or CPT code 93930 and CPT code 93931 with CPT code 93985 or CPT code 93986.

Utilization Parameters

Non-invasive arterial duplexes in the upper or lower extremities (CPT 93925, 93926, 93930, or 93931) should not be performed more than once per year apart from preoperative planning, post-surgical intervention, or inpatient/emergency visits. In such circumstances, when more than one arterial duplex study is performed aside from preoperative planning, post-surgical intervention, or inpatient/emergency services, a documentation review to validate that the services were reasonable and necessary will be made on redetermination.

Only one preoperative scan (CPT 93925, 93926, 93930, or 93931) is considered reasonable and necessary for bypass surgery and should be billed by the surgical provider performing the procedure.

Post-operative surgical intervention monitoring with arterial duplex ultrasound, including the initial pre-planning study, is allowable at a maximum of 6 studies (initial pre-operative, immediate post-operative, and intervals in the post-operative period at 1 month, 3 months, 6 months, and 12 months) in the first year and then annually thereafter. The billed date of surgery must be documented on arterial duplex claims in block/box 19 of the claims form during the post-operative period.

Documentation Requirements

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
Images of all relevant areas, both normal and abnormal, must be recorded and stored in a retrievable format (electronic preferred).
A signed final report of the ultrasound findings and impression must be included in the patient’s medical record and is the definitive documentation of the study. The final report must include, but is not limited to the following demographic components:
- A description of examination findings, using appropriate anatomic and ultrasound terminology (use of acronyms and abbreviations should be avoided).
- The concluding statements or summary of the report should include these components:
  - An impression, conclusion, or summary statement
  - A specific diagnosis or differential diagnosis, if appropriate
  - A recommendation for follow-up studies, if clinically applicable
  - An accounting of any failure to include standard views or other necessary components (as listed in the appropriate practice parameter)
  - If prior relevant imaging studies were reviewed, a statement of comparison should be included
  - Details concerning any provider-to-provider communication in cases in which a delay in communication may have an adverse effect on the patient’s outcome.
An order from the treating physician/nonphysician practitioner as required by CFR, Title 42, Volume 2, Chapter IV, Part 410.32(a) Ordering diagnostic tests.

Response To Comments

Number	Comment	Response
1

Coding Information

Bill Type Codes

Code	Description
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Revenue Codes

Code	Description
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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

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Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(409 Codes)

Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 93925, 93926, 93930, and 93931.

Group 1 Codes

Code	Description
A48.0	Gas gangrene
E08.51	Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene
E08.52	Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene
E08.59	Diabetes mellitus due to underlying condition with other circulatory complications
E09.51	Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene
E09.52	Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene
E09.59	Drug or chemical induced diabetes mellitus with other circulatory complications
E10.51	Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E10.52	Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.59	Type 1 diabetes mellitus with other circulatory complications
E11.51	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E11.52	Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E11.59	Type 2 diabetes mellitus with other circulatory complications
E11.621	Type 2 diabetes mellitus with foot ulcer
E11.622	Type 2 diabetes mellitus with other skin ulcer
E11.628	Type 2 diabetes mellitus with other skin complications
E13.51	Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene
E13.52	Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene
E13.59	Other specified diabetes mellitus with other circulatory complications
I25.10	Atherosclerotic heart disease of native coronary artery without angina pectoris
I70.211	Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212	Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213	Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.221	Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222	Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223	Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.231	Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232	Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233	Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234	Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235	Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.238	Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg
I70.241	Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242	Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243	Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244	Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245	Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.248	Atherosclerosis of native arteries of left leg with ulceration of other part of lower leg
I70.261	Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262	Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263	Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.291	Other atherosclerosis of native arteries of extremities, right leg
I70.292	Other atherosclerosis of native arteries of extremities, left leg
I70.293	Other atherosclerosis of native arteries of extremities, bilateral legs
I70.511	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.512	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.513	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.521	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, right leg
I70.522	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, left leg
I70.523	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.531	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh
I70.532	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of calf
I70.533	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle
I70.534	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.535	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot
I70.538	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of lower leg
I70.541	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh
I70.542	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of calf
I70.543	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of ankle
I70.544	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.545	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot
I70.548	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of lower leg
I70.561	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, right leg
I70.562	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, left leg
I70.563	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.591	Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg
I70.592	Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, left leg
I70.593	Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs
I70.611	Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.612	Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.613	Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.621	Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, right leg
I70.622	Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, left leg
I70.623	Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.631	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh
I70.632	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of calf
I70.633	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of ankle
I70.634	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.635	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of foot
I70.638	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of lower leg
I70.641	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh
I70.642	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of calf
I70.643	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of ankle
I70.644	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.645	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of foot
I70.648	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of lower leg
I70.661	Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, right leg
I70.662	Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, left leg
I70.663	Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.691	Other atherosclerosis of nonbiological bypass graft(s) of the extremities, right leg
I70.692	Other atherosclerosis of nonbiological bypass graft(s) of the extremities, left leg
I70.693	Other atherosclerosis of nonbiological bypass graft(s) of the extremities, bilateral legs
I70.92	Chronic total occlusion of artery of the extremities
I72.1	Aneurysm of artery of upper extremity
I72.3	Aneurysm of iliac artery
I72.4	Aneurysm of artery of lower extremity
I73.00	Raynaud's syndrome without gangrene
I73.01	Raynaud's syndrome with gangrene
I73.1	Thromboangiitis obliterans [Buerger's disease]
I73.9*	Peripheral vascular disease, unspecified
I74.2	Embolism and thrombosis of arteries of the upper extremities
I74.3	Embolism and thrombosis of arteries of the lower extremities
I74.5	Embolism and thrombosis of iliac artery
I75.011	Atheroembolism of right upper extremity
I75.012	Atheroembolism of left upper extremity
I75.013	Atheroembolism of bilateral upper extremities
I75.021	Atheroembolism of right lower extremity
I75.022	Atheroembolism of left lower extremity
I75.023	Atheroembolism of bilateral lower extremities
I76	Septic arterial embolism
I77.0	Arteriovenous fistula, acquired
I77.1	Stricture of artery
I77.2	Rupture of artery
I77.3	Arterial fibromuscular dysplasia
I77.5	Necrosis of artery
I77.72	Dissection of iliac artery
I77.76	Dissection of artery of upper extremity
I77.77	Dissection of artery of lower extremity
I77.82	Antineutrophilic cytoplasmic antibody [ANCA] vasculitis
I77.89	Other specified disorders of arteries and arterioles
I96	Gangrene, not elsewhere classified
M30.0	Polyarteritis nodosa
M30.1	Polyarteritis with lung involvement [Churg-Strauss]
M30.8	Other conditions related to polyarteritis nodosa
M31.0	Hypersensitivity angiitis
M31.10	Thrombotic microangiopathy, unspecified
M31.11	Hematopoietic stem cell transplantation-associated thrombotic microangiopathy [HSCT-TMA]
M31.19	Other thrombotic microangiopathy
M31.7	Microscopic polyangiitis
M31.8	Other specified necrotizing vasculopathies
Q27.31	Arteriovenous malformation of vessel of upper limb
Q27.32	Arteriovenous malformation of vessel of lower limb
S25.111A	Minor laceration of right innominate or subclavian artery, initial encounter
S25.111D	Minor laceration of right innominate or subclavian artery, subsequent encounter
S25.111S	Minor laceration of right innominate or subclavian artery, sequela
S25.112A	Minor laceration of left innominate or subclavian artery, initial encounter
S25.112D	Minor laceration of left innominate or subclavian artery, subsequent encounter
S25.112S	Minor laceration of left innominate or subclavian artery, sequela
S25.121A	Major laceration of right innominate or subclavian artery, initial encounter
S25.121D	Major laceration of right innominate or subclavian artery, subsequent encounter
S25.121S	Major laceration of right innominate or subclavian artery, sequela
S25.122A	Major laceration of left innominate or subclavian artery, initial encounter
S25.122D	Major laceration of left innominate or subclavian artery, subsequent encounter
S25.122S	Major laceration of left innominate or subclavian artery, sequela
S25.191A	Other specified injury of right innominate or subclavian artery, initial encounter
S25.191D	Other specified injury of right innominate or subclavian artery, subsequent encounter
S25.191S	Other specified injury of right innominate or subclavian artery, sequela
S25.192A	Other specified injury of left innominate or subclavian artery, initial encounter
S25.192D	Other specified injury of left innominate or subclavian artery, subsequent encounter
S25.192S	Other specified injury of left innominate or subclavian artery, sequela
S45.011A	Laceration of axillary artery, right side, initial encounter
S45.011D	Laceration of axillary artery, right side, subsequent encounter
S45.011S	Laceration of axillary artery, right side, sequela
S45.012A	Laceration of axillary artery, left side, initial encounter
S45.012D	Laceration of axillary artery, left side, subsequent encounter
S45.012S	Laceration of axillary artery, left side, sequela
S45.091A	Other specified injury of axillary artery, right side, initial encounter
S45.091D	Other specified injury of axillary artery, right side, subsequent encounter
S45.091S	Other specified injury of axillary artery, right side, sequela
S45.092A	Other specified injury of axillary artery, left side, initial encounter
S45.092D	Other specified injury of axillary artery, left side, subsequent encounter
S45.092S	Other specified injury of axillary artery, left side, sequela
S45.111A	Laceration of brachial artery, right side, initial encounter
S45.111D	Laceration of brachial artery, right side, subsequent encounter
S45.111S	Laceration of brachial artery, right side, sequela
S45.112A	Laceration of brachial artery, left side, initial encounter
S45.112D	Laceration of brachial artery, left side, subsequent encounter
S45.112S	Laceration of brachial artery, left side, sequela
S45.191A	Other specified injury of brachial artery, right side, initial encounter
S45.191D	Other specified injury of brachial artery, right side, subsequent encounter
S45.191S	Other specified injury of brachial artery, right side, sequela
S45.192A	Other specified injury of brachial artery, left side, initial encounter
S45.192D	Other specified injury of brachial artery, left side, subsequent encounter
S45.192S	Other specified injury of brachial artery, left side, sequela
S55.011A	Laceration of ulnar artery at forearm level, right arm, initial encounter
S55.011D	Laceration of ulnar artery at forearm level, right arm, subsequent encounter
S55.011S	Laceration of ulnar artery at forearm level, right arm, sequela
S55.012A	Laceration of ulnar artery at forearm level, left arm, initial encounter
S55.012D	Laceration of ulnar artery at forearm level, left arm, subsequent encounter
S55.012S	Laceration of ulnar artery at forearm level, left arm, sequela
S55.091A	Other specified injury of ulnar artery at forearm level, right arm, initial encounter
S55.091D	Other specified injury of ulnar artery at forearm level, right arm, subsequent encounter
S55.091S	Other specified injury of ulnar artery at forearm level, right arm, sequela
S55.092A	Other specified injury of ulnar artery at forearm level, left arm, initial encounter
S55.092D	Other specified injury of ulnar artery at forearm level, left arm, subsequent encounter
S55.092S	Other specified injury of ulnar artery at forearm level, left arm, sequela
S55.111A	Laceration of radial artery at forearm level, right arm, initial encounter
S55.111D	Laceration of radial artery at forearm level, right arm, subsequent encounter
S55.111S	Laceration of radial artery at forearm level, right arm, sequela
S55.112A	Laceration of radial artery at forearm level, left arm, initial encounter
S55.112D	Laceration of radial artery at forearm level, left arm, subsequent encounter
S55.112S	Laceration of radial artery at forearm level, left arm, sequela
S55.191A	Other specified injury of radial artery at forearm level, right arm, initial encounter
S55.191D	Other specified injury of radial artery at forearm level, right arm, subsequent encounter
S55.191S	Other specified injury of radial artery at forearm level, right arm, sequela
S55.192A	Other specified injury of radial artery at forearm level, left arm, initial encounter
S55.192D	Other specified injury of radial artery at forearm level, left arm, subsequent encounter
S55.192S	Other specified injury of radial artery at forearm level, left arm, sequela
S65.011A	Laceration of ulnar artery at wrist and hand level of right arm, initial encounter
S65.011D	Laceration of ulnar artery at wrist and hand level of right arm, subsequent encounter
S65.011S	Laceration of ulnar artery at wrist and hand level of right arm, sequela
S65.012A	Laceration of ulnar artery at wrist and hand level of left arm, initial encounter
S65.012D	Laceration of ulnar artery at wrist and hand level of left arm, subsequent encounter
S65.012S	Laceration of ulnar artery at wrist and hand level of left arm, sequela
S65.091A	Other specified injury of ulnar artery at wrist and hand level of right arm, initial encounter
S65.091D	Other specified injury of ulnar artery at wrist and hand level of right arm, subsequent encounter
S65.091S	Other specified injury of ulnar artery at wrist and hand level of right arm, sequela
S65.092A	Other specified injury of ulnar artery at wrist and hand level of left arm, initial encounter
S65.092D	Other specified injury of ulnar artery at wrist and hand level of left arm, subsequent encounter
S65.092S	Other specified injury of ulnar artery at wrist and hand level of left arm, sequela
S65.111A	Laceration of radial artery at wrist and hand level of right arm, initial encounter
S65.111D	Laceration of radial artery at wrist and hand level of right arm, subsequent encounter
S65.111S	Laceration of radial artery at wrist and hand level of right arm, sequela
S65.112A	Laceration of radial artery at wrist and hand level of left arm, initial encounter
S65.112D	Laceration of radial artery at wrist and hand level of left arm, subsequent encounter
S65.112S	Laceration of radial artery at wrist and hand level of left arm, sequela
S65.191A	Other specified injury of radial artery at wrist and hand level of right arm, initial encounter
S65.191D	Other specified injury of radial artery at wrist and hand level of right arm, subsequent encounter
S65.191S	Other specified injury of radial artery at wrist and hand level of right arm, sequela
S65.192A	Other specified injury of radial artery at wrist and hand level of left arm, initial encounter
S65.192D	Other specified injury of radial artery at wrist and hand level of left arm, subsequent encounter
S65.192S	Other specified injury of radial artery at wrist and hand level of left arm, sequela
S65.211A	Laceration of superficial palmar arch of right hand, initial encounter
S65.211D	Laceration of superficial palmar arch of right hand, subsequent encounter
S65.211S	Laceration of superficial palmar arch of right hand, sequela
S65.212A	Laceration of superficial palmar arch of left hand, initial encounter
S65.212D	Laceration of superficial palmar arch of left hand, subsequent encounter
S65.212S	Laceration of superficial palmar arch of left hand, sequela
S65.291A	Other specified injury of superficial palmar arch of right hand, initial encounter
S65.291D	Other specified injury of superficial palmar arch of right hand, subsequent encounter
S65.291S	Other specified injury of superficial palmar arch of right hand, sequela
S65.292A	Other specified injury of superficial palmar arch of left hand, initial encounter
S65.292D	Other specified injury of superficial palmar arch of left hand, subsequent encounter
S65.292S	Other specified injury of superficial palmar arch of left hand, sequela
S65.311A	Laceration of deep palmar arch of right hand, initial encounter
S65.311D	Laceration of deep palmar arch of right hand, subsequent encounter
S65.311S	Laceration of deep palmar arch of right hand, sequela
S65.312A	Laceration of deep palmar arch of left hand, initial encounter
S65.312D	Laceration of deep palmar arch of left hand, subsequent encounter
S65.312S	Laceration of deep palmar arch of left hand, sequela
S65.391A	Other specified injury of deep palmar arch of right hand, initial encounter
S65.391D	Other specified injury of deep palmar arch of right hand, subsequent encounter
S65.391S	Other specified injury of deep palmar arch of right hand, sequela
S65.392A	Other specified injury of deep palmar arch of left hand, initial encounter
S65.392D	Other specified injury of deep palmar arch of left hand, subsequent encounter
S65.392S	Other specified injury of deep palmar arch of left hand, sequela
S75.011A	Minor laceration of femoral artery, right leg, initial encounter
S75.011D	Minor laceration of femoral artery, right leg, subsequent encounter
S75.011S	Minor laceration of femoral artery, right leg, sequela
S75.012A	Minor laceration of femoral artery, left leg, initial encounter
S75.012D	Minor laceration of femoral artery, left leg, subsequent encounter
S75.012S	Minor laceration of femoral artery, left leg, sequela
S75.021A	Major laceration of femoral artery, right leg, initial encounter
S75.021D	Major laceration of femoral artery, right leg, subsequent encounter
S75.021S	Major laceration of femoral artery, right leg, sequela
S75.022A	Major laceration of femoral artery, left leg, initial encounter
S75.022D	Major laceration of femoral artery, left leg, subsequent encounter
S75.022S	Major laceration of femoral artery, left leg, sequela
S75.091A	Other specified injury of femoral artery, right leg, initial encounter
S75.091D	Other specified injury of femoral artery, right leg, subsequent encounter
S75.091S	Other specified injury of femoral artery, right leg, sequela
S75.092A	Other specified injury of femoral artery, left leg, initial encounter
S75.092D	Other specified injury of femoral artery, left leg, subsequent encounter
S75.092S	Other specified injury of femoral artery, left leg, sequela
S85.011A	Laceration of popliteal artery, right leg, initial encounter
S85.011D	Laceration of popliteal artery, right leg, subsequent encounter
S85.011S	Laceration of popliteal artery, right leg, sequela
S85.012A	Laceration of popliteal artery, left leg, initial encounter
S85.012D	Laceration of popliteal artery, left leg, subsequent encounter
S85.012S	Laceration of popliteal artery, left leg, sequela
S85.091A	Other specified injury of popliteal artery, right leg, initial encounter
S85.091D	Other specified injury of popliteal artery, right leg, subsequent encounter
S85.091S	Other specified injury of popliteal artery, right leg, sequela
S85.092A	Other specified injury of popliteal artery, left leg, initial encounter
S85.092D	Other specified injury of popliteal artery, left leg, subsequent encounter
S85.092S	Other specified injury of popliteal artery, left leg, sequela
S85.141A	Laceration of anterior tibial artery, right leg, initial encounter
S85.141D	Laceration of anterior tibial artery, right leg, subsequent encounter
S85.141S	Laceration of anterior tibial artery, right leg, sequela
S85.142A	Laceration of anterior tibial artery, left leg, initial encounter
S85.142D	Laceration of anterior tibial artery, left leg, subsequent encounter
S85.142S	Laceration of anterior tibial artery, left leg, sequela
S85.151A	Other specified injury of anterior tibial artery, right leg, initial encounter
S85.151D	Other specified injury of anterior tibial artery, right leg, subsequent encounter
S85.151S	Other specified injury of anterior tibial artery, right leg, sequela
S85.152A	Other specified injury of anterior tibial artery, left leg, initial encounter
S85.152D	Other specified injury of anterior tibial artery, left leg, subsequent encounter
S85.152S	Other specified injury of anterior tibial artery, left leg, sequela
S85.171A	Laceration of posterior tibial artery, right leg, initial encounter
S85.171D	Laceration of posterior tibial artery, right leg, subsequent encounter
S85.171S	Laceration of posterior tibial artery, right leg, sequela
S85.172A	Laceration of posterior tibial artery, left leg, initial encounter
S85.172D	Laceration of posterior tibial artery, left leg, subsequent encounter
S85.172S	Laceration of posterior tibial artery, left leg, sequela
S85.181A	Other specified injury of posterior tibial artery, right leg, initial encounter
S85.181D	Other specified injury of posterior tibial artery, right leg, subsequent encounter
S85.181S	Other specified injury of posterior tibial artery, right leg, sequela
S85.182A	Other specified injury of posterior tibial artery, left leg, initial encounter
S85.182D	Other specified injury of posterior tibial artery, left leg, subsequent encounter
S85.182S	Other specified injury of posterior tibial artery, left leg, sequela
S85.211A	Laceration of peroneal artery, right leg, initial encounter
S85.211D	Laceration of peroneal artery, right leg, subsequent encounter
S85.211S	Laceration of peroneal artery, right leg, sequela
S85.212A	Laceration of peroneal artery, left leg, initial encounter
S85.212D	Laceration of peroneal artery, left leg, subsequent encounter
S85.212S	Laceration of peroneal artery, left leg, sequela
S85.291A	Other specified injury of peroneal artery, right leg, initial encounter
S85.291D	Other specified injury of peroneal artery, right leg, subsequent encounter
S85.291S	Other specified injury of peroneal artery, right leg, sequela
S85.292A	Other specified injury of peroneal artery, left leg, initial encounter
S85.292D	Other specified injury of peroneal artery, left leg, subsequent encounter
S85.292S	Other specified injury of peroneal artery, left leg, sequela
S95.011A	Laceration of dorsal artery of right foot, initial encounter
S95.011D	Laceration of dorsal artery of right foot, subsequent encounter
S95.011S	Laceration of dorsal artery of right foot, sequela
S95.012A	Laceration of dorsal artery of left foot, initial encounter
S95.012D	Laceration of dorsal artery of left foot, subsequent encounter
S95.012S	Laceration of dorsal artery of left foot, sequela
S95.091A	Other specified injury of dorsal artery of right foot, initial encounter
S95.091D	Other specified injury of dorsal artery of right foot, subsequent encounter
S95.091S	Other specified injury of dorsal artery of right foot, sequela
S95.092A	Other specified injury of dorsal artery of left foot, initial encounter
S95.092D	Other specified injury of dorsal artery of left foot, subsequent encounter
S95.092S	Other specified injury of dorsal artery of left foot, sequela
S95.111A	Laceration of plantar artery of right foot, initial encounter
S95.111D	Laceration of plantar artery of right foot, subsequent encounter
S95.111S	Laceration of plantar artery of right foot, sequela
S95.112A	Laceration of plantar artery of left foot, initial encounter
S95.112D	Laceration of plantar artery of left foot, subsequent encounter
S95.112S	Laceration of plantar artery of left foot, sequela
S95.191A	Other specified injury of plantar artery of right foot, initial encounter
S95.191D	Other specified injury of plantar artery of right foot, subsequent encounter
S95.191S	Other specified injury of plantar artery of right foot, sequela
S95.192A	Other specified injury of plantar artery of left foot, initial encounter
S95.192D	Other specified injury of plantar artery of left foot, subsequent encounter
S95.192S	Other specified injury of plantar artery of left foot, sequela
T80.1XXA	Vascular complications following infusion, transfusion and therapeutic injection, initial encounter
T80.1XXD	Vascular complications following infusion, transfusion and therapeutic injection, subsequent encounter
T80.1XXS	Vascular complications following infusion, transfusion and therapeutic injection, sequela
T81.718A	Complication of other artery following a procedure, not elsewhere classified, initial encounter
T81.718D	Complication of other artery following a procedure, not elsewhere classified, subsequent encounter
T81.718S	Complication of other artery following a procedure, not elsewhere classified, sequela
T82.312A	Breakdown (mechanical) of femoral arterial graft (bypass), initial encounter
T82.312D	Breakdown (mechanical) of femoral arterial graft (bypass), subsequent encounter
T82.312S	Breakdown (mechanical) of femoral arterial graft (bypass), sequela
T82.318A	Breakdown (mechanical) of other vascular grafts, initial encounter
T82.318D	Breakdown (mechanical) of other vascular grafts, subsequent encounter
T82.318S	Breakdown (mechanical) of other vascular grafts, sequela
T82.322A	Displacement of femoral arterial graft (bypass), initial encounter
T82.322D	Displacement of femoral arterial graft (bypass), subsequent encounter
T82.322S	Displacement of femoral arterial graft (bypass), sequela
T82.328A	Displacement of other vascular grafts, initial encounter
T82.328D	Displacement of other vascular grafts, subsequent encounter
T82.328S	Displacement of other vascular grafts, sequela
T82.332A	Leakage of femoral arterial graft (bypass), initial encounter
T82.332D	Leakage of femoral arterial graft (bypass), subsequent encounter
T82.332S	Leakage of femoral arterial graft (bypass), sequela
T82.338A	Leakage of other vascular grafts, initial encounter
T82.338D	Leakage of other vascular grafts, subsequent encounter
T82.338S	Leakage of other vascular grafts, sequela
T82.392A	Other mechanical complication of femoral arterial graft (bypass), initial encounter
T82.392D	Other mechanical complication of femoral arterial graft (bypass), subsequent encounter
T82.392S	Other mechanical complication of femoral arterial graft (bypass), sequela
T82.398A	Other mechanical complication of other vascular grafts, initial encounter
T82.398D	Other mechanical complication of other vascular grafts, subsequent encounter
T82.398S	Other mechanical complication of other vascular grafts, sequela
T82.518A	Breakdown (mechanical) of other cardiac and vascular devices and implants, initial encounter
T82.518D	Breakdown (mechanical) of other cardiac and vascular devices and implants, subsequent encounter
T82.518S	Breakdown (mechanical) of other cardiac and vascular devices and implants, sequela
T82.528A	Displacement of other cardiac and vascular devices and implants, initial encounter
T82.528D	Displacement of other cardiac and vascular devices and implants, subsequent encounter
T82.528S	Displacement of other cardiac and vascular devices and implants, sequela
T82.538A	Leakage of other cardiac and vascular devices and implants, initial encounter
T82.538D	Leakage of other cardiac and vascular devices and implants, subsequent encounter
T82.538S	Leakage of other cardiac and vascular devices and implants, sequela
T82.598A	Other mechanical complication of other cardiac and vascular devices and implants, initial encounter
T82.598D	Other mechanical complication of other cardiac and vascular devices and implants, subsequent encounter
T82.598S	Other mechanical complication of other cardiac and vascular devices and implants, sequela
T82.7XXA	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter
T82.7XXD	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, subsequent encounter
T82.7XXS	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, sequela
T82.818A	Embolism due to vascular prosthetic devices, implants and grafts, initial encounter
T82.818D	Embolism due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.818S	Embolism due to vascular prosthetic devices, implants and grafts, sequela
T82.828A	Fibrosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.828D	Fibrosis due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.828S	Fibrosis due to vascular prosthetic devices, implants and grafts, sequela
T82.838A	Hemorrhage due to vascular prosthetic devices, implants and grafts, initial encounter
T82.838D	Hemorrhage due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.838S	Hemorrhage due to vascular prosthetic devices, implants and grafts, sequela
T82.848A	Pain due to vascular prosthetic devices, implants and grafts, initial encounter
T82.848D	Pain due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.848S	Pain due to vascular prosthetic devices, implants and grafts, sequela
T82.858A	Stenosis of other vascular prosthetic devices, implants and grafts, initial encounter
T82.858D	Stenosis of other vascular prosthetic devices, implants and grafts, subsequent encounter
T82.858S	Stenosis of other vascular prosthetic devices, implants and grafts, sequela
T82.868A	Thrombosis due to vascular prosthetic devices, implants and grafts, initial encounter
T82.868D	Thrombosis due to vascular prosthetic devices, implants and grafts, subsequent encounter
T82.868S	Thrombosis due to vascular prosthetic devices, implants and grafts, sequela
T82.898A	Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter
T82.898D	Other specified complication of vascular prosthetic devices, implants and grafts, subsequent encounter
T82.898S	Other specified complication of vascular prosthetic devices, implants and grafts, sequela
T87.0X1	Complications of reattached (part of) right upper extremity
T87.0X2	Complications of reattached (part of) left upper extremity
T87.1X1	Complications of reattached (part of) right lower extremity
T87.1X2	Complications of reattached (part of) left lower extremity
Z01.810	Encounter for preprocedural cardiovascular examination
Z95.820	Peripheral vascular angioplasty status with implants and grafts
Z98.62	Peripheral vascular angioplasty status

Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10-CM code I73.9 for reporting intermittent claudication.

ICD-10-CM Codes that DO NOT Support Medical Necessity

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Group 1

(1 Code)

Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes

Code	Description
XX000	Not Applicable

ICD-10-PCS Codes

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Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code	Description
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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code	Description
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Other Coding Information

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion
			N/A	N/A

Non-Excluded CPT/HCPCS Ended Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion

Revision History Information

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Associated Documents

Related Local Coverage Documents
LCDs
DL40276 - Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

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Contents

Billing and Coding: Non-Invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

Document Note

Note History

Contractor Information

Draft Article Information

General Information

CMS National Coverage Policy

Article Guidance

Response To Comments

Coding Information

Bill Type Codes

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Revenue Codes

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

ICD-10-CM Codes that Support Medical Necessity

Group 1

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

ICD-10-PCS Codes

Group 1

Additional ICD-10 Information

Bill Type Codes

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Revenue Codes

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Other Coding Information

Group 1

Coding Table Information

Revision History Information

Associated Documents

Keywords

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