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Diagnostic carotid and cerebral angiography: a historical summary of the evolving changes in coding and reimbursement in a complex procedure family
  1. William D Donovan1,
  2. Thabele M Leslie-Mazwi2,
  3. Ezequiel Silva III3,
  4. Henry H Woo4,
  5. Gregory N Nicola5,
  6. Robert M Barr6,
  7. Jacqueline A Bello7,
  8. Raymond Tu8,
  9. Joshua A Hirsch2
  1. 1The William W. Backus Hospital, Norwich, Connecticut, USA
  2. 2Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3South Texas Radiology Group, Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
  4. 4Department of Neurological Surgery and Radiology, Cerebrovascular Center, Stony Brook University Medical Center, Stony Brook, New York, USA
  5. 5Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA
  6. 6Mecklenburg Radiology Associates P.A., Charlotte, North Carolina, USA
  7. 7Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
  8. 8Department of Progressive Radiology, The George Washington University, Falls Church, Virginia, USA
  1. Correspondence to Dr Joshua A Hirsch, Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA, hirsch{at}


Carotid and cerebral angiography have been a mainstay of neurointerventional and neuroradiologic practice for years. Centers for Medicare and Medicaid Services (CMS) and Relative Value Scale Update Committee (RUC) initiatives have compelled the professional societies to bundle component codes under threat of unilateral CMS revision and revaluation. Code bundling usually results in a decrease in the professional Relative Value Unit (RVU) valuation, and thus the MD reimbursement. The year 2013 saw a dramatic revision to the Current Procedural Terminology (CPT) code set that defines carotid and cerebral procedures. This paper reviews the process that led to that code set being revised and estimates the impact on professional reimbursement. We show the current and previous carotid angiography CPT codes and use clinical examples to assess professional RVU valuation before and after code revision.

  • Angiography

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