CPT code 37291: Atherectomy, complex, each additional vessel2026 Medicare rate & RVUs
Reports complex atherectomy in an additional tibial or peroneal vessel during catheter-based lower-extremity revascularization for peripheral arterial disease.
Medicare pays $1,075.51 for 37291 nationally in the office and $292.93 in a hospital or facility. Local office rates run $938.96–$1,437.95.
Medicare rate · 37291
Atherectomy, complex, each additional vessel
- Work RVUs
- 6.5
- Total RVUs
- 32.20
- Global days
- ZZZ
National rate · 2026
$1,075.51
Office setting, before claim adjustments.
See every locality for 37291 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What 37291 covers
This add-on code describes atherectomy in an additional tibial or peroneal vessel during endovascular treatment of lower-extremity arterial disease. A vascular surgeon, interventional radiologist, or interventional cardiologist may perform the catheter-based procedure in an angiography or operating suite for limb ischemia caused by obstructive disease. Atherectomy removes or debulks plaque to restore blood flow; angioplasty associated with the atherectomy is part of the revascularization service, rather than a separate angioplasty-only service in that vessel.
Report 37291 only with the appropriate primary procedure, such as 37290 for complex atherectomy in the first vessel. Use it for an additional vessel that meets the complex category’s criteria; document the treated vessels, lesion characteristics supporting that classification, and the atherectomy performed. CMS pays this add-on within the primary procedure’s global period. For a bilateral procedure reported with modifier 50, CMS pays 150%.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 37291 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$938.96 to $1437.95
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $954.28 | $269.52 |
| Alaska | $1,216.68 | $383.23 |
| Arizona | $1,043.80 | $285.48 |
| Arkansas | $938.96 | $266.72 |
| Atlanta, GA | $1,098.24 | $303.13 |
| Austin, TX | $1,117.97 | $290.00 |
| Bakersfield, CA | $1,140.08 | $282.37 |
| Baltimore area, MD | $1,149.04 | $309.33 |
| Beaumont, TX | $999.11 | $286.96 |
| Brazoria, TX | $1,060.01 | $284.47 |
| Chicago, IL | $1,139.49 | $352.99 |
| Chico, CA | $1,136.36 | $278.64 |
| Colorado | $1,120.29 | $287.62 |
| Connecticut | $1,151.95 | $309.10 |
| Dallas, TX | $1,067.81 | $288.35 |
| Delaware | $1,062.28 | $289.09 |
| Detroit, MI | $1,077.98 | $322.78 |
| East St. Louis, IL | $1,056.17 | $336.19 |
| El Centro, CA | $1,136.58 | $278.87 |
| Fort Lauderdale, FL | $1,122.52 | $329.76 |
| Fort Worth, TX | $1,060.26 | $288.63 |
| Fresno, CA | $1,136.36 | $278.64 |
| Galveston, TX | $1,063.80 | $286.69 |
| Hanford, CA | $1,136.36 | $278.64 |
| Hawaii, Guam, HI | $1,167.95 | $278.15 |
| Houston, TX | $1,088.51 | $311.40 |
| Idaho | $986.68 | $266.70 |
| Indiana | $992.96 | $267.51 |
| Iowa | $979.19 | $263.12 |
| Kansas | $975.07 | $267.61 |
| Kentucky | $981.40 | $285.68 |
| King County, WA | $1,262.73 | $302.50 |
| Los Angeles, CA | $1,218.10 | $292.30 |
| Madera, CA | $1,136.36 | $278.64 |
| Manhattan, NY | $1,247.58 | $338.22 |
| Marin County, CA | $1,405.20 | $301.76 |
| Merced, CA | $1,136.36 | $278.64 |
| Metropolitan Boston, MA | $1,237.23 | $302.83 |
| Metropolitan Kansas City, MO | $1,024.86 | $290.01 |
| Metropolitan Philadelphia, PA | $1,121.47 | $306.80 |
| Metropolitan St. Louis, MO | $1,036.56 | $291.54 |
| Miami, FL | $1,177.80 | $363.13 |
| Minnesota | $1,067.35 | $262.07 |
| Mississippi | $950.69 | $276.89 |
| Modesto, CA | $1,136.36 | $278.64 |
| Montana | $1,075.42 | $292.84 |
| Napa, CA | $1,325.63 | $294.19 |
| Nebraska | $984.84 | $262.51 |
| Nevada | $1,068.79 | $285.43 |
| New Hampshire | $1,103.22 | $288.55 |
| New Mexico | $1,017.07 | $299.44 |
| New Orleans, LA | $1,033.66 | $297.25 |
| North Carolina | $1,004.74 | $274.59 |
| North Dakota | $1,048.72 | $266.14 |
| Northern New Jersey | $1,222.38 | $314.59 |
| NYC suburbs and Long Island, NY | $1,281.76 | $351.27 |
| Ohio | $1,005.11 | $290.61 |
| Oklahoma | $978.43 | $279.58 |
| Oxnard, CA | $1,212.61 | $287.60 |
| Portland, OR | $1,157.72 | $288.27 |
| Poughkeepsie and northern NYC suburbs, NY | $1,172.01 | $315.08 |
| Puerto Rico | $1,083.78 | $292.59 |
| Queens, NY | $1,257.36 | $332.34 |
| Redding, CA | $1,136.36 | $278.64 |
| Rest of California | $1,136.36 | $278.64 |
| Rest of Florida | $1,062.40 | $314.25 |
| Rest of Georgia | $996.33 | $298.26 |
| Rest of Illinois | $1,030.14 | $315.64 |
| Rest of Louisiana | $980.08 | $287.50 |
| Rest of Maine | $993.40 | $273.42 |
| Rest of Maryland | $1,083.74 | $291.77 |
| Rest of Massachusetts | $1,112.93 | $288.87 |
| Rest of Michigan | $1,010.57 | $296.07 |
| Rest of Missouri | $962.10 | $287.51 |
| Rest of New Jersey | $1,163.39 | $308.81 |
| Rest of New York | $1,021.45 | $278.00 |
| Rest of Oregon | $1,058.86 | $279.41 |
| Rest of Pennsylvania | $1,006.34 | $287.93 |
| Rest of Texas | $1,029.66 | $286.98 |
| Rest of Washington | $1,110.66 | $286.60 |
| Rhode Island | $1,101.60 | $293.20 |
| Riverside, CA | $1,150.87 | $293.16 |
| Sacramento, CA | $1,194.97 | $284.83 |
| Salinas, CA | $1,190.63 | $283.62 |
| San Benito County, CA | $1,437.95 | $309.47 |
| San Diego, CA | $1,220.78 | $284.81 |
| San Francisco, CA | $1,403.66 | $300.22 |
| San Luis Obispo, CA | $1,171.33 | $279.97 |
| Santa Clara County, CA | $1,431.68 | $303.20 |
| Santa Cruz, CA | $1,234.01 | $283.17 |
| Santa Maria, CA | $1,195.68 | $283.18 |
| Santa Rosa, CA | $1,246.53 | $285.52 |
| South Carolina | $1,006.93 | $283.83 |
| South Dakota | $1,045.57 | $262.99 |
| Southern Maine, ME | $1,051.55 | $276.01 |
| Stockton, CA | $1,136.36 | $278.64 |
| Suburban Chicago, IL | $1,133.80 | $330.09 |
| Tennessee | $980.62 | $269.25 |
| Utah | $1,022.11 | $286.48 |
| Vallejo, CA | $1,323.43 | $291.98 |
| Vermont | $1,045.10 | $270.34 |
| Virgin Islands, VI | $1,083.78 | $292.59 |
| Virginia | $1,048.43 | $279.15 |
| Visalia, CA | $1,136.36 | $278.64 |
| Washington, DC area | $1,237.10 | $315.21 |
| West Virginia | $988.40 | $308.33 |
| Wisconsin | $1,010.15 | $260.43 |
| Wyoming | $1,063.79 | $281.20 |
| Yuba City, CA | $1,136.36 | $278.64 |
37291 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$938.96
$1,287.16
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $1,216.68 | 1 |
| AL | $954.28 | 1 |
| AR | $938.96 | 1 |
| AZ | $1,043.80 | 1 |
| CA | $1,136.36–$1,437.95 | 29 |
| CO | $1,120.29 | 1 |
| CT | $1,151.95 | 1 |
| DC | $1,237.10 | 1 |
| DE | $1,062.28 | 1 |
| FL | $1,062.40–$1,177.80 | 3 |
| GA | $996.33–$1,098.24 | 2 |
| GU | $1,167.95 | 1 |
| HI | $1,167.95 | 1 |
| IA | $979.19 | 1 |
| ID | $986.68 | 1 |
| IL | $1,030.14–$1,139.49 | 4 |
| IN | $992.96 | 1 |
| KS | $975.07 | 1 |
| KY | $981.40 | 1 |
| LA | $980.08–$1,033.66 | 2 |
| MA | $1,112.93–$1,237.23 | 2 |
| MD | $1,083.74–$1,237.10 | 3 |
| ME | $993.40–$1,051.55 | 2 |
| MI | $1,010.57–$1,077.98 | 2 |
| MN | $1,067.35 | 1 |
| MO | $962.10–$1,036.56 | 3 |
| MS | $950.69 | 1 |
| MT | $1,075.42 | 1 |
| NC | $1,004.74 | 1 |
| ND | $1,048.72 | 1 |
| NE | $984.84 | 1 |
| NH | $1,103.22 | 1 |
| NJ | $1,163.39–$1,222.38 | 2 |
| NM | $1,017.07 | 1 |
| NV | $1,068.79 | 1 |
| NY | $1,021.45–$1,281.76 | 5 |
| OH | $1,005.11 | 1 |
| OK | $978.43 | 1 |
| OR | $1,058.86–$1,157.72 | 2 |
| PA | $1,006.34–$1,121.47 | 2 |
| PR | $1,083.78 | 1 |
| RI | $1,101.60 | 1 |
| SC | $1,006.93 | 1 |
| SD | $1,045.57 | 1 |
| TN | $980.62 | 1 |
| TX | $999.11–$1,117.97 | 8 |
| UT | $1,022.11 | 1 |
| VA | $1,048.43–$1,237.10 | 2 |
| VI | $1,083.78 | 1 |
| VT | $1,045.10 | 1 |
| WA | $1,110.66–$1,262.73 | 2 |
| WI | $1,010.15 | 1 |
| WV | $988.40 | 1 |
| WY | $1,063.79 | 1 |
How the 37291 rate is calculated
Each of 37291’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 37291
RVUs × geographic indexes × conversion factor
Work6.50
6.50 RVUs× 1.000 GPCI
Practice expense24.35
24.35 RVUs× 1.000 GPCI
Malpractice1.35
1.35 RVUs× 1.000 GPCI
Adjusted RVUs
32.2000
Conversion factor
$33.4009
Medicare rate
$1,075.51
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 37291
The CMS indicators that decide how 37291 is paid alongside other services.
CMS payment indicators · 37291
Atherectomy, complex, each additional vessel
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
37291 without 50 · national office
$1,075.51
Atherectomy, complex, each additional vessel
37291-50 · Bilateral: 150%
$1,613.27
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
37291 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 37290Peripheral atherectomyComplex, initial vessel
- 37290 is for complex atherectomy in the first vessel; 37291 is for each additional qualifying vessel.
- 37289Arterial atherectomyAdditional simple vessel
- 37289 describes atherectomy in an additional vessel in the simple category. Use 37291 when the additional-vessel service meets the complex category’s criteria.
- 37295Tibial revascularizationComplex additional vessel
- 37295 applies when complex treatment in each additional vessel combines stenting and atherectomy; 37291 describes the complex atherectomy service without that combined treatment.
- 37283AngioplastyComplex, each additional vessel
- 37283 is for complex angioplasty in an additional vessel without atherectomy. Use 37291 when atherectomy is performed in the additional vessel.
37291 billing questions
When is 37291 used instead of 37290?
Use 37290 for the first vessel treated with complex atherectomy. Report 37291 for each additional qualifying vessel in the complex category.
Can 37291 be billed by itself?
No. It is an add-on code and must be reported with an appropriate primary procedure, such as 37290.
Is angioplasty separately reported in the atherectomy vessel?
Angioplasty associated with atherectomy in that vessel is included in the revascularization service; 37291 represents the additional-vessel atherectomy service.
What documentation supports the complex additional-vessel service?
Document the treated tibial or peroneal vessel, the lesion characteristics supporting complex classification, and the atherectomy performed.
How does CMS handle bilateral reporting?
For a bilateral procedure reported with modifier 50, CMS pays 150%. The add-on code must still be reported with its primary procedure.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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