Effective January 1, 2026, the American Medical Association (AMA) has introduced a complete overhaul of the Lower Extremity Revascularization (LER) coding system. The previous code range (37220–37235) has been deleted and replaced by a more granular set of 46 new codes (37254–37299) designed to better reflect modern endovascular techniques and procedural complexity.
Key Structural Changes
The 2026 updates shift from a three-territory model to a four-territory model and introduce specific terminology for lesion complexity.
Four Vascular Territories:
- Iliac: Common, external, and internal iliac arteries.
- Femoral/Popliteal: Divided into two billable vessels: 1) Common femoral/profunda femoris and 2) Superficial femoral (SFA)/popliteal.
- Tibial/Peroneal: Anterior tibial, posterior tibial, and peroneal arteries.
- Inframalleolar (New): Covers arteries below the ankle, including the dorsalis pedis and plantar arteries.
Lesion Complexity Definitions:
-
- Straightforward: Defined strictly as stenosis.
- Complex: Defined strictly as 100% occlusion.
- Technology-Specific Add-Ons: Dedicated codes have been added for intravascular lithotripsy (IVL), which was previously not properly reportable.
Bundled vs. Separately Reportable Services
The new codes (37254–37299) are comprehensive and bundle several components that were previously sometimes reported separately.
| Included in LER Codes (Bundled) | Separately Reportable |
| Vascular access and selective catheterization | Extensive arterial repair or replacement (35226, 35286) |
| Lesion crossing and definitive intervention | Mechanical thrombectomy or thrombolysis |
| All intraprocedural imaging and guidance | Intravascular ultrasound (IVUS) |
| Radiological supervision and interpretation (RS&I) | Moderate sedation |
| Arteriotomy closure (manual, device, or suture) | Diagnostic angiogram (only if from a separate access) |
Important Coding Rules & Modifiers
- Unilateral Designation: All LER codes are unilateral. If a primary procedure is performed bilaterally, append modifier 50.
- Add-On Codes: Used for distinct lesions in different vessels within a territory. They cannot take modifier 50; if performed bilaterally, they must be reported twice with modifier 59 or XS.
- Hierarchy: If multiple interventions (e.g., angioplasty and stenting) are performed in the same vessel, report only the most intensive service (e.g., stenting).
Territory Limits:
- Iliac: Up to 2 add-on codes.
- Femoral/Popliteal: 1 add-on code.
- Tibial/Peroneal: Up to 2 add-on codes.
- Inframalleolar: 1 add-on code; only angioplasty is typically coded here.
Crosswalk: Legacy Codes vs. 2026 Replacement Strategy
The table below illustrates how the old 2025 codes map to the new 2026 structure. Instead of a 1-to-1 replacement, each old code now splits into multiple specific options based on the lesion’s complexity.
| 2025 Deleted Code | Procedure Description | 2026 Replacement Category | New Code Range Examples |
| 37220 – 37223 | Iliac (Angioplasty/Stent) | Iliac Territory | 37254 – 37262 |
| 37224 – 37227 | Femoral/Popliteal (PTA/Stent) | Fem/Pop Territory | 37263 – 37279 |
| 37228 – 37231 | Tibial/Peroneal (PTA/Stent) | Tib/Per Territory | 37280 – 37295 |
| 37232 – 37235 | Add-on for addl. Vessels | Territory Add-ons | Specific per territory |
| (New Territory) | Below the Ankle | Inframalleolar | 37296 – 37299 |
Detailed Comparison by Vascular Territory
1. Iliac Territory (37254–37262)
Previously, codes like 37221 covered iliac stenting regardless of complexity. Now, you must choose based on the vessel and the lesion type.
- Initial Vessel: Use 37254 (Angioplasty, Straightforward) or 37256 (Stent, Straightforward).
- Complex Lesion: If the vessel is 100% occluded, use 37258 (Angioplasty, Complex) or 37260 (Stent, Complex).
- New Tech: Intravascular Lithotripsy (IVL) now has a dedicated add-on code (37262).
2. Femoral/Popliteal Territory (37263–37279)
This territory is now split into two billable vessels: 1) Common femoral/profunda and 2) SFA/popliteal.
- Straightforward (Stenosis): Codes 37263–37270 cover PTA, stenting, and atherectomy.
- Complex (Occlusion): Codes 37271–37278 are used for total occlusions.
- Atherectomy: Unlike the iliac territory, atherectomy is bundled into several primary codes in this region (e.g., 37267).
3. Tibial/Peroneal Territory (37280–37295)
The rules for the anterior/posterior tibial and peroneal arteries follow a similar split between stenosis and occlusion.
- Initial Vessel: Codes 37280–37287 cover the first vessel treated.
- Additional Vessels: Up to two add-on codes (37288–37295) can be reported for the remaining two tibial/peroneal vessels.
4. Inframalleolar Territory (37296–37299)
This is an entirely new territory for 2026, covering the dorsalis pedis and plantar arteries.
- Procedures: Only angioplasty is typically reported here (37296 for straightforward, 37298 for complex).
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