(2022) CPT 93922 – CPT 93931 Descriptions & Guidelines (Non-Invasive Extremity Arterial Studies)

Non invastive extremity arterial studies can be reported with CPT 93922, CPT 93923, CPT 93923, CPT 93924, CPT 93925, CPT 93926, CPT 93930 & CPT 93931.

The coding guidelines can be found below followed by the descriptions of the CPT codes. Reimbursement will be explained at the end of the article.

Coding Guidelines

The Ankle-Brachial Index (or ABI) can be reported with CPT 93923 or CPT 93923. The code won’t be denied as long as the following is performed:

• transcutaneous oxygen tension measurements;
• volume plethysmography; or
• simultaneous Doppler recording and analysis of bidirectional blood flow.

CPT 93922, CPT 93923 and CPT 93924 can be reported for:

• Plethysmography;
• oxygen tension measurements appropriate for the anatomic area studied; and or
• the evaluation of non imaging physiologic recordings of pressures with Doppler analysis of bi directional blood flow.

Limited studies for lower extremity require one of the following: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis;

1. arteries with transcutaneous oxygen tension measurements at one or two evels. Potential levels include;
   • toes;
   • metatarsal;
   • ankle;
   • calf;
   • low thigh; and
   • high thigh.
2. arteries plus volume plethysmography at one or two levels; or
3. arteries plus bidirectional Doppler waveform recording and analysis at one or two levels;

Limited studies for upper extremity require Doppler determined systolic pressure and;

1. transcutaneous oxygen tension measurements at one or two levels. Potential levels include:
   • digits;
   • forearm ;
   • wrist; and
   • arm.
2. volume plethysmography at one or two levels; or
3. bidirectional Doppler waveform recording and analysis at one or two levels.

Complete studies for lower extremity require either: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries;

1. with transcutaneous oxygen tension measurements at 3+ levels. A complete study may be reported as well with measurements at a single level if provocative functional maneuvers are performed. For example:
   • measurements with reactive hyperemia; or
   • measurements with postural provocative tests.
2. plus volume plethysmography at 3+ levels.
3. plus bidirectional Doppler waveform recording and analysis at 3+ levels.

Complete studies for upper extremity require either: Doppler-determined systolic pressures and;

1. and transcutaneous oxygen tension measurements at 3+ levels. A complete study may be reported as well with measurements at a single level if provocative functional maneuvers are performed. For example measurements with cold stress or measurements with postural provocative tests.
   Potential levels include;
   • digits;
   • wrist;
   • forearm; and
   • arm.
2. volume plethysmography at 3+ levels; or
3. bidirectional Doppler waveform recording and analysis at 3+ levels.

93922 CPT Code

93922 CPT Code Description: Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries.

CPT 93922 examples for lower extremity: Ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries;

• with transcutaneous oxygen tension measurement at 1 or 2 levels;
• plus volume plethysmography at 1 or 2 levels;
• plus bidirectional. Doppler waveform recording and analysis at 1 or 2 levels.

93923 CPT Code

93923 CPT Code Description: Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries. 3+ levels.

CPT 93923 examples for lower extremity:

1. Single level study with provocative functional maneuvers (e.g. measurements with reactive hyperemia or measurements with postural provocative tests.
2. ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries;
   • plus segmental transcutaneous oxygen tension measurements (3+ levels).
   • plus segmental volume plethysmography (3+ levels).
   • plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis (3+ levels).

93924 CPT Code

93924 CPT Code Description: Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, that is:

Volume plethysmography recording and analysis at rest or bidirectional Doppler waveform with ankle/brachial indices immediately after and at timed intervals following performance of a standardized protocol on a motorized treadmill plus recording of time of onset of claudication or other symptoms.

Time to recovery and maximal walking time.

Do not use CPT 93924 with CPT 93923 and CPT 93922. CPT 93924 can be reported as complete bilateral study.

93925 CPT Code

93925 CPT Code Description: Duplex scan of arterial bypass grafts or lower extremity arteries. This code is a complete bilateral study.

Don’t use CPT 93925 with CPT 93985 when the extremities are the same.

TIP: You can find the complete billing guide for CPT code 93925 here.

93926 CPT Code

93926 CPT Code Description: Duplex scan of lower extremity arteries or arterial bypass grafts. CPT 93926 can be used for limited or unilateral study.

93930 CPT Code

93930 CPT Code Description: Complete bilateral study. Duplex scan of upper extremity arteries or arterial bypass grafts.

93931 CPT Code

93931 CPT Code Description: Limited study or unilateral study. Duplex scan of upper extremity arteries or arterial bypass grafts.

Reimbursement

Noninvasive vascular procedures will not be covered when performed based on internal protocols of the testing facility; a referral for one non-invasive study is not a blanket referral for all studies.

The provider treating the patient must specifically order the procedures in writing; an order must be on record for each non-invasive study performed.

When an uninterpretable study (i.e., poor quality or not in accordance with regulatory standards) results in performing another type of study, only the successful study should be billed. 

For example, when an uninterpretable non-invasive physiologic study (CPT code 93922, CPT 93923 or CPT 93924) is performed which results in performing a duplex scan (CPT 93925 or CPT 93926 ), only the duplex scan should be billed.

Performance of both a physiological test (CPT 93922, CPT 93923 and CPT 93924) and duplex scanning (CPT 93925 and CPT 93926) of extremity arteries during the same encounter would not generally be expected.

Consequently, documentation must clearly support the medical necessity if both procedures are performed during the same encounter, and be available to Medicare upon request.

Note: Reimbursement of physiologic testing will not be allowed after a duplex scan has been performed.

Since the signs and symptoms of arterial occlusive disease and venous disease are so divergent, the performance of simultaneous arterial and venous studies during the same encounter should be rare.

Consequently, documentation must clearly support the medical necessity of both procedures if performed during the same encounter.