Appeal type: Practitioner Services
Decision: Partially Favorable

 
We decided that the Plan has to pay for 37225, 75625 and 75710. We decided that the Plan does not have to 
pay for 37220.  
 
You asked the Plan to pay for procedure codes 37220, 37225, 75625, and 75710 rendered on December 13, 
2022.. You say that this should be paid for. The Plan says that the records do not support the services billed. 
 We decided that the Plan has to pay for 37225, 75625 and 75710.  
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. 
 
In this case, the CPT Code Manual definition of the overturned codes is: 
 
CPT 37225: 
 
Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with 
atherectomy, includes angioplasty within the same vessel, when performed 
 
CPT 75625: 
 
Aortography, abdominal, by serialography, radiological supervision and interpretation 
 
CPT 75710: 
 
Angiography, extremity, unilateral, radiological supervision and interpretation 
 
We asked our physician reviewer to carefully review the case file and apply the relevant Medicare rules to 
determine if the Plan was correct in denying the request for these codes. Our reviewer says that CPT 37225 
codes for femoral atherectomy with or without percutaneous transluminal angioplasty (PTA). There is 
satisfactory documentation of femoral atherectomy and PTA. 
 
Additionally, CPT 75625 and 75710 code for angiography of the aorta and a unilateral extremity. These codes 
are separately billable (and not bundled with the intervention code) if there is no recent previous angiogram 
available and there is satisfactory description of findings.  In this case there is no evidence of recent 
angiography, and the description of findings are satisfactory.  
 
We looked at this physician's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of the services have been met. Therefore, we decided that the Plan has to pay for 
37225, 75625 and 75710.  
 
We also decided that the Plan does not have to pay for 37220. 
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. 
 
In this case, the CPT Code Manual definition of CPT 37220 is "Revascularization, endovascular, open or 
percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty." 
 
We asked our physician reviewer to carefully review the case file and apply the relevant Medicare rules to 
determine if the Plan was correct in denying the request for CPT 37220. Our reviewer says that this codes for 
tibial balloon angioplasty. This work is includedin CPT 37229 that has already been billed and covered. 
Adding CPT 37220 would not be appropriate. 
 
We looked at this physician's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of 37220 have not been met. Therefore, we decided that the Plan does not have to 
pay for 37220. 
 If the Plan does not agree with our decision, they can ask us to open a case again. We only open a case again 
if we believe there was a mistake or if there is new information to review. The Plan has to show us the mistake 
and/or send us the new information. This does not happen often. If we decide to open the case again, we will 
send you a letter.