Crystal's MCW Coder Hub🩺 CPT 61626 — Transcatheter Permanent Occlusion or Embolization, Non-CNS Head or Neck
Full Description
CPT 61626 describes a percutaneous transcatheter permanent arterial occlusion or embolization performed in the head or neck vessels outside of the central nervous system — specifically targeting the extracranial, brachiocephalic branch vasculature (i.e., vessels supplied by the external carotid artery and its branches, branches of the subclavian artery, and other extracranial vessels). The procedure is performed for three primary purposes: tumor destruction/devascularization, hemostasis (hemorrhage control), or vascular malformation occlusion.
The interventional physician gains vascular access (typically via the common femoral artery in the groin, though radial artery access is increasingly used), advances a catheter system under fluoroscopic guidance through the aorta and into the target extracranial artery, selectively navigates to the feeding vessel of the target lesion, and then deploys embolic materials through the catheter to permanently occlude the vessel. Embolic agents may include:
- Coils (platinum detachable microcoils — durable, precise, for vessel occlusion)
- Particles (polyvinyl alcohol/PVA particles, Embosphere microspheres — for tumor devascularization)
- Liquid agents (n-butyl cyanoacrylate/NBCA glue, Onyx — for AVMs and fistulas)
- Gelfoam (temporary, often used in trauma/epistaxis)
- Combination approaches (coils + particles or liquid agents for complex cases)
The selection of embolic agent depends on the target vessel caliber, the lesion type, the desired permanence of occlusion, and proximity to critical structures.
CY 2026 Critical Coding Change — RS&I Now Bundled
Effective January 1, 2026, CPT 61626 was significantly revised by the AMA CPT Editorial Panel to include all radiological supervision and interpretation (RS&I), intraprocedural roadmapping, and imaging guidance within the procedure code itself. This is one of the most impactful coding changes for interventional radiology in 2026.
Before 2026:
61626 - Embolization (intervention only)
75894 - RS&I, transcatheter therapy, infusion or embolization, any method (separately billed)
75898 - Follow-up angiography (sometimes separately billed)
After 2026 (Current):
61626 - Embolization INCLUDING all RS&I, intraprocedural roadmapping,
and imaging guidance
→ 75894 is NO LONGER separately billable with 61626
→ 75898 (follow-up angiography): review current 2026 CPT
guidance — consult AMA and your MAC for latest parenthetical
note instructions
This bundling change means that the total wRVU assigned to 61626 was adjusted upward in 2026 to account for the incorporated RS&I work, and practices can no longer report the imaging guidance codes alongside the intervention. Any claim submitted with 75894 on the same date as 61626 will be denied by Medicare and most commercial payers under NCCI bundling effective January 1, 2026.
Clinical Indications — What 61626 Is Used For
CPT 61626 is applicable across a broad range of clinical scenarios in the extracranial head and neck vascular territory:
Hemorrhage Control (Hemostasis):
- Refractory posterior epistaxis failing surgical ligation (used when 31241 or 30920 are not feasible, failed, or contraindicated)
- Post-surgical or post-traumatic head/neck hemorrhage from extracranial vessels
- Hemoptysis from bronchial or intercostal arteries — note: verify territory; some hemoptysis cases may use 37241 instead
- Maxillofacial trauma with uncontrolled arterial bleeding
Tumor Devascularization (Pre-operative):
- Juvenile nasopharyngeal angiofibroma (JNA) — most common pediatric head/neck tumor embolization
- Paragangliomas (glomus jugulare, glomus tympanicum, carotid body tumor)
- Hemangioblastomas of the head/neck
- Hypervascular metastases to the skull base or cervical spine
- Meningiomas with external carotid supply (borderline — may cross to 61624 if intracranial)
Vascular Malformation Occlusion:
- Arteriovenous malformations (AVMs) of the scalp, face, neck
- Arteriovenous fistulas (AVFs) in the extracranial head/neck
- Venous malformations with arterial component requiring embolization
61626 vs. 61624 — CNS vs. Non-CNS Distinction
The most critical code selection decision in head/neck embolization is whether the target vessel is CNS (61624) or non-CNS (61626):
| Code | Territory | Examples |
|---|---|---|
| 61624 | Central Nervous System (intracranial, spinal cord) | Cerebral aneurysm, intracranial AVM, dural AV fistula, cavernous-carotid fistula with intracranial supply |
| 61626 | Non-CNS Head or Neck (extracranial, brachiocephalic) | Epistaxis via IMA/SPA, JNA devascularization, paraganglioma, scalp AVM, neck AVF |
The vessel’s anatomy and the clinical effect of embolization — not the approach — determine CNS vs. non-CNS:
- If the target is an intracranial artery or its supply affects the brain/spinal cord: 61624
- If the target is an extracranial artery (external carotid branch, vertebral extracranial segment, subclavian branch): 61626
Borderline Cases: The internal carotid artery (ICA) at the skull base can be complex. A high cervical ICA aneurysm that affects cerebral circulation is generally coded 61624 even though it is technically at the skull base (extracranial). The question is whether embolization of the target vessel would impact cerebral perfusion. When in doubt, document the clinical rationale for the code selected.
Important: CPT 61624 is designated an inpatient-only procedure (Status Indicator C) for Medicare patients in the hospital outpatient/ASC setting. CPT 61626 does NOT carry the inpatient-only designation and can be performed and billed in outpatient hospital or ASC settings.
Code Family / Code Tree
Endovascular Therapy — Embolization Codes (Nervous System Section)
│
├── 61624 - Transcatheter permanent occlusion or embolization;
│ CENTRAL NERVOUS SYSTEM (intracranial, spinal cord)
│ Examples: cerebral aneurysm, intracranial AVM,
│ dural AV fistula
│ Status: Inpatient-only (CMS) — C indicator
│ wRVU: ~8.75 (similar to 61626)
│ RS&I bundled into code as of 2026
│ Global: 000
│
├── 61626 ◄ YOU ARE HERE
│ Transcatheter permanent occlusion or embolization;
│ NON-CNS HEAD OR NECK (extracranial, brachiocephalic)
│ Examples: epistaxis, JNA, paraganglioma,
│ scalp/neck AVM, head/neck hemorrhage
│ Not inpatient-only — outpatient/ASC eligible
│ RS&I bundled into code as of 2026
│ Global: 000
│
├── 61630 - Balloon angioplasty, intracranial (adjunctive)
│
├── 61635 - Transcatheter placement of intravascular stent(s),
│ intracranial (adjunctive)
│
└── PERIPHERAL EMBOLIZATION CODES (non-head/neck):
├── 37241 - Vascular embolization or occlusion (venous)
│ (non-head/neck vascular territory)
├── 37242 - Arterial embolization, non-tumor
├── 37243 - Arterial embolization, tumor or organ ischemia
└── 37244 - Arterial embolization, hemorrhage
Related Angiography/Catheter Placement Codes (separately billable
when diagnostic study is performed at same session):
├── 36217 - Selective catheter placement, thoracic aorta branch
│ (2nd order — separately reportable)
├── 36218 - Each additional 2nd order or higher thoracic
│ branch (add-on, with 36217)
└── 75894 - RS&I, transcatheter embolization
⚠️ NOT separately billable with 61626 as of Jan 1, 2026
Catheter Placement Codes (36217, 36218) — Separately Reportable: Unlike 75894 (RS&I), catheter placement codes may remain separately reportable alongside 61626 when a diagnostic angiography is not performed at the same session. When a diagnostic angiography (e.g., 36224 for cerebral, 36228 for external carotid) IS performed at the same session, the catheter placement is bundled into the diagnostic angiography code. Consult your practice’s IR coding specialist and current NCCI edits for the specific vessel combination.
Includes (Bundled — Do NOT Bill Separately) — Effective CY 2026
As of January 1, 2026, the following are fully bundled into CPT 61626:
- All fluoroscopic imaging guidance used during the procedure
- All intraprocedural roadmapping (real-time fluoroscopic roadmap overlays)
- Radiological supervision and interpretation (RS&I) of the embolization — 75894 is NO LONGER separately reportable
- Embolic agent delivery (regardless of number of coils, particles, or liquid agent aliquots deployed in a single target vessel)
- Positioning and navigation of the catheter system during the embolization
- Basic completion angiography to confirm occlusion of the target vessel
- All physician work involved in interpreting imaging during the procedure
- Moderate sedation (if performed by the same physician doing the procedure — use 99152/99153 only if a second physician provides sedation)
- Standard post-procedure monitoring and care on the day of service
Excludes / Cannot Bill With (Same Session)
| Code | Status | Notes |
|---|---|---|
| 75894 | BUNDLED as of 2026 | No longer separately billable with 61626 under any circumstance as of Jan 1, 2026 |
| 75898 (Follow-up angiography) | Review 2026 guidance | Previously separately billable; verify current AMA parenthetical notes and MAC guidance — may be bundled |
| 61624 (CNS embolization) | Mutually exclusive | Select one code based on CNS vs. non-CNS territory; do not bill both unless clearly separate, distinct vessel territories are embolized with explicit documentation |
| 31238 or 31241 (Endoscopic epistaxis) | Mutually exclusive for same bleed | Do not bill 61626 AND a surgical ligation code for the same bleeding episode on the same date; select the approach used |
| 30920 (Transantral IMA ligation) | Mutually exclusive for same session | Cannot bill open and endovascular approaches for the same hemorrhage on the same date |
Separately Reportable on the Same Day:
- 36217/36218 (catheter placement, selective) — may be separately reportable if a diagnostic angiogram was not performed; consult current NCCI edits
- Diagnostic angiography codes (36224, 36225, 36226, 36227, 36228) — separately reportable when a diagnostic angiographic study is performed in addition to the therapeutic embolization, as long as the diagnostic findings are separately documented and the diagnostic study was medically necessary in addition to the therapeutic procedure
- 99152/99153 (moderate sedation by a separate provider) — separately reportable when a second physician (not the IR performing the procedure) administers moderate sedation
- Pathology/biopsy codes — if tissue sampling is performed at the same session, separately reportable with appropriate documentation
Modifier -26 / -TC Split Billing
CPT 61626, like most diagnostic and procedural radiology codes, is subject to professional/technical component split billing in hospital-based or facility settings:
| Modifier | Who Bills | What’s Included |
|---|---|---|
| No modifier (global) | Independent practice or ASC owning equipment | IR physician performs and interprets; practice owns the equipment and facility |
| -26 (Professional Component) | Hospital-employed IR physician or contracted radiologist | Physician work only: catheter navigation, embolization, interpretation |
| -TC (Technical Component) | Hospital or facility | Equipment, room, nursing, fluoroscopy unit, embolic materials |
In most hospital-based IR settings, the physician bills 61626-26 and the facility bills a separate APC (Ambulatory Payment Classification) for the technical component under OPPS. The physician and facility are billed separately; the combined reimbursement approximates the global non-facility rate.
Assistant at Surgery
Not applicable. CPT 61626 is an interventional radiology procedure performed percutaneously. The concept of an assistant surgeon does not apply. A single interventional radiologist or neurointerventional surgeon typically performs the procedure, occasionally with a fellow or scrub technologist assisting but not in an independently billable capacity.
For complex cases requiring two physicians (rare — e.g., concurrent surgical exposure and IR access), consult payer-specific policy. Standard Medicare MPFS does not support a co-surgeon or assistant payment for 61626.
wRVU and Reimbursement
Note: The CY 2026 wRVU for 61626 was adjusted upward from prior years to account for the bundling of RS&I work into the procedure code. Pre-2026 values included separate 75894 reporting; the 2026 values reflect the consolidated approach.
| Component | Non-Facility | Facility (-26 modifier) |
|---|---|---|
| Work RVU (wRVU) | ~8.75 | ~8.75 |
| Practice Expense RVU | ~3.55 | ~0.55 (facility PE reduced per 2026 rule) |
| Malpractice RVU | ~1.30 | ~1.20 |
| Total RVU (approx.) | ~13.60 | ~10.50 |
| Medicare National Rate (est.) | ~500 | ~410 (physician component only) |
| Facility APC/Technical Payment | N/A | Billed separately by facility under OPPS |
| Typical Commercial Rate Range | 2,000+ | Highly variable by payer contract |
CY 2026 Radiology Impact Note: While 61626 benefited from the RS&I bundling (upward wRVU adjustment), the 2026 CMS final rule’s 50% reduction of indirect PE RVUs in the facility setting created downward pressure on total RVU calculations for facility-based IR. The net estimated impact on interventional radiology overall is approximately +2% due to the RS&I bundling benefit outweighing the PE reduction. Individual code impacts vary. Non-facility and office-based IR providers saw a more favorable net outcome.
Pre-2026 Comparison for Context:
- Pre-2026: 61626 (~6.0 wRVU) + 75894 (~2.25 wRVU) = ~8.25 wRVU combined when both billed
- Post-2026: 61626 (~8.75 wRVU) alone = comparable total valuation, now in one code
Global Period
| Element | Detail |
|---|---|
| Global Period | 000 (Zero-day) |
| Pre-op Day Included | None |
| Post-op Days Included | None |
| What’s Bundled | Procedure-related care on the same day |
CPT 61626 carries a 000-day global period, consistent with its classification as an endovascular/interventional procedure rather than a major open surgery. There is no bundled post-operative care package. All follow-up encounters — femoral access site checks, repeat imaging, post-procedure angiography on a subsequent date — are separately billable on their respective dates of service.
Modifier -25 (Same-Day E/M): A significant, separately identifiable E/M service on the same day as 61626 may be separately reported with Modifier -25 on the E/M code. Because the global is 000 (minor procedure), -25 is the correct modifier — not -57, which is reserved for major surgery (090 global) decision encounters.
HCC (Hierarchical Condition Category)
CPT 61626 is a procedural code and does not directly map to HCC risk-adjustment categories. HCC scores are driven entirely by ICD-10-CM diagnosis codes on the claim.
The diagnoses accompanying 61626 vary substantially based on indication and may carry significant HCC relevance:
| Indication | Typical ICD-10-CM | HCC Relevance |
|---|---|---|
| Epistaxis | R04.0 | No HCC |
| Hemophilia A | D66 | HCC 46 (Coagulation Defects) |
| Hemophilia B | D67 | HCC 46 |
| Active malignancy, nasal/neck | C30.0, C11.9, C76.0 | HCC 10-12 (Cancer) |
| Hereditary hemorrhagic telangiectasia | Q78.0 | Generally not HCC |
| Paraganglioma (malignant) | C75.5 | HCC 10-12 (Cancer) |
| AVM intracranial (non-CNS territory) | Q28.2 | Not typically HCC |
| Coagulopathy | D68.32, D68.9 | Monitor |
CPT 61626 itself: HCC Not Applicable.
MS-DRG Applicability
Because 61626 is frequently performed in an inpatient hospital setting — particularly for refractory epistaxis, tumor devascularization before or during a surgical admission, or post-traumatic hemorrhage — MS-DRG assignment is clinically relevant and commonly encountered.
The MS-DRG depends on the primary diagnosis and ICD-10-PCS procedure coding, not on the CPT code. The facility assigns an ICD-10-PCS code to capture the embolization procedure.
ICD-10-PCS Approximate Construct for Inpatient 61626-Equivalent:
- Section: 0 (Medical and Surgical) or 3 (Administration — for liquid embolic agents)
- Body System: 3 (Upper Arteries) — for external carotid branches
- Root Operation: L (Occlusion) — permanent occlusion/ligation of vessel
- Approach: 3 (Percutaneous) — transcatheter/endovascular
- Device: D (Intraluminal Device) — coils or other permanent devices
Example approximate code: 03LK3DZ (Occlusion of Internal Carotid Artery, Percutaneous Approach, Intraluminal Device) — verify with current-year PCS tables; code assignment depends on specific vessel targeted
Relevant MS-DRGs by Indication:
For Epistaxis (R04.0) as principal diagnosis:
| MS-DRG | Title |
|---|---|
| 150 | Epistaxis with MCC |
| 151 | Epistaxis without MCC |
For Head/Neck Tumor (Malignant) as principal diagnosis:
| MS-DRG | Title |
|---|---|
| 10 | Unspecified intracranial hemorrhage with MCC (if cerebrovascular) |
| 579 | Other skin, subcut tis & breast procedures with MCC |
| 582 | Mastectomy for malignancy with CC/MCC (if breast primary) |
| 133-135 | Other ear, nose, mouth and throat O.R. procedures (ENT-MDC 03) |
For AVM / Vascular Malformation as principal diagnosis:
| MS-DRG | Title |
|---|---|
| 023 | Craniotomy with major device implant or acute complex CNS PDX with MCC (if CNS territory involvement) |
| 025 | Craniotomy and endovascular intracranial procedures with MCC |
| 026 | Craniotomy and endovascular intracranial procedures with CC |
| 027 | Craniotomy and endovascular intracranial procedures without CC/MCC |
Inpatient facility coding note: Because 61626 is not inpatient-only (unlike 61624), many cases are coded in the outpatient setting and MS-DRGs are not applicable. When inpatient admission occurs, ICD-10-PCS codes — not CPT codes — drive the DRG grouping. The IR physician separately submits their professional claim (CPT 61626-26) under the MPFS regardless of the inpatient facility coding.
Common ICD-10-CM Diagnosis Codes Paired with CPT 61626
Epistaxis / Hemorrhage Control
| ICD-10-CM | Description |
|---|---|
| R04.0 | Epistaxis (primary dx for hemorrhage control indication) |
| I10 | Essential hypertension |
| D68.32 | Hemorrhagic disorder due to extrinsic anticoagulants |
| D68.9 | Coagulation defect, unspecified |
| D66 | Hereditary factor VIII deficiency (Hemophilia A) |
| D67 | Hereditary factor IX deficiency (Hemophilia B) |
| D69.3 | Immune thrombocytopenic purpura |
| D69.59 | Other secondary thrombocytopenia |
| Q78.0 | Hereditary hemorrhagic telangiectasia (HHT) |
| T45.515A | Adverse effect of anticoagulants, initial encounter |
| T45.515D | Adverse effect of anticoagulants, subsequent encounter |
| Z79.01 | Long-term use of anticoagulants |
Tumor Devascularization
| ICD-10-CM | Description |
|---|---|
| D10.6 | Benign neoplasm of nasopharynx (juvenile nasopharyngeal angiofibroma — JNA) |
| C30.0 | Malignant neoplasm of nasal cavity |
| C11.9 | Malignant neoplasm of nasopharynx, unspecified |
| C76.0 | Malignant neoplasm of head, face, and neck (when not otherwise specified) |
| D44.7 | Neoplasm of uncertain behavior of other endocrine glands (paraganglioma) |
| C75.5 | Malignant neoplasm of aortic body and other paraganglia |
| D35.6 | Benign neoplasm of carotid body (carotid body tumor) |
| D13.7 | Benign neoplasm of other specified digestive organs (glomus jugulare) |
| D36.7 | Benign neoplasm of other specified sites (paraganglioma of neck) |
| C41.0 | Malignant neoplasm of bones of skull and face |
| C79.51 | Secondary malignant neoplasm of bone — skull base metastases |
Vascular Malformations
| ICD-10-CM | Description |
|---|---|
| Q28.2 | Arteriovenous malformation of cerebral vessels (if non-CNS territory) |
| Q28.3 | Other malformations of cerebral vessels |
| Q27.30 | Arteriovenous malformation, site unspecified |
| Q27.31 | AVM of vessel of upper limb |
| Q27.33 | AVM of digestive system vessel |
| Q27.39 | AVM, other site (head/neck non-CNS) |
| Q18.0 | Sinus, fistula, and cyst of branchial cleft (related vascular anomalies) |
| D18.00 | Hemangioma, unspecified site |
| D18.09 | Hemangioma of other sites (head/neck AVM overlap) |
| I77.0 | Arteriovenous fistula, acquired |
Trauma
| ICD-10-CM | Description |
|---|---|
| S09.90xA | Unspecified injury of head, initial encounter |
| S10.91xA | Unspecified superficial injury of neck, initial encounter |
| S15.001A | Unspecified injury of right carotid artery, initial encounter |
| S15.002A | Unspecified injury of left carotid artery, initial encounter |
| S15.009A | Unspecified injury of unspecified carotid artery, initial encounter |
| T14.91xA | Suicide attempt, initial encounter (traumatic hemorrhage with self-harm) |
Coding Examples
Example 1 — Refractory Epistaxis, Embolization After Failed Surgical Ligation
Clinical Scenario: A 71-year-old patient with known HHT (Osler-Weber-Rendu) presents with severe recurrent right posterior epistaxis. She previously underwent right endoscopic SPA ligation (31241) six months ago. Now presents with recurrent bleeding from the same side. ENT evaluates and refers to IR. Angiography demonstrates persistent collateral supply to the posterior nasal cavity from the right internal maxillary artery branches. IR performs transcatheter embolization of the right internal maxillary artery and its branches using PVA particles and a final coil. Post-embolization angiography demonstrates complete occlusion of the target vessels and cessation of flow to the nasal cavity.
IR Physician Bills (Facility Setting):
CPT: 61626-26-RT - Transcatheter permanent occlusion or
embolization; non-CNS head or neck;
professional component; right side
ICD-10: R04.0 - Epistaxis
Q78.0 - Hereditary hemorrhagic telangiectasia
Z87.39 - Personal history of prior SPA ligation
(prior procedure — document in note)
Facility Bills (OPPS/APC):
CPT: 61626-TC-RT - Technical component
(Hospital submits on UB-04; physician on CMS-1500)
Note
As of 2026, 75894 is NOT separately billed alongside 61626. The RS&I is fully bundled.
Example 2 — Juvenile Nasopharyngeal Angiofibroma, Pre-operative Devascularization
Clinical Scenario: A 15-year-old male with biopsy-confirmed JNA is scheduled for endoscopic resection. One day before surgery, IR performs pre-operative embolization of the feeding vessels (bilateral internal maxillary artery branches and ascending pharyngeal artery) to reduce intraoperative blood loss. Selective angiography confirms devascularization of the tumor.
Day Before Surgery — IR Embolization:
CPT: 61626-50 - Transcatheter permanent occlusion or
embolization; non-CNS head or neck;
bilateral (bilateral feeding vessel
embolization documented)
ICD-10: D10.6 - Benign neoplasm of nasopharynx (JNA)
Day of Surgery — ENT Endoscopic Resection (separate claim):
CPT: 31240 or appropriate resection code
ICD-10: D10.6
Note
Bilateral embolization of tumor feeding vessels — Modifier -50 or -LT/-RT per payer policy. Document in the procedure note that bilateral feeding vessels were embolized and each side required selective catheterization and embolic deployment.
Example 3 — Paraganglioma (Glomus Jugulare), Pre-Surgical Embolization
Clinical Scenario: Patient with a right glomus jugulare tumor (paraganglioma of the jugular foramen) is scheduled for neurosurgical resection. IR performs pre-operative embolization of the tumor’s arterial supply (primarily from the ascending pharyngeal and posterior auricular arteries — branches of the external carotid artery). The entire procedure targets only extracranial ECA branches.
CPT: 61626-26-RT - Transcatheter permanent occlusion or
embolization; non-CNS head or neck;
professional component
ICD-10: D35.6 - Benign neoplasm of carotid body
(use D44.7 if behavior uncertain;
C75.5 if malignant paraganglioma)
Note
Critical code selection check: If during the same session the IR physician also embolizes an intracranial feeding vessel to the tumor (e.g., a branch of the posterior inferior cerebellar artery or meningeal branch), that portion would be coded 61624 (CNS territory). Document each vessel territory separately in the procedure note if both CNS and non-CNS vessels are embolized.
Example 4 — Scalp AVM Embolization
Clinical Scenario: A 34-year-old patient presents with a symptomatic pulsatile scalp arteriovenous malformation involving branches of the right superficial temporal artery and occipital artery. IR performs transcatheter embolization using NBCA liquid embolic agent via selective catheterization of the right external carotid artery branches. No intracranial involvement.
CPT: 61626-26-RT - Transcatheter permanent occlusion or
embolization; non-CNS head or neck;
professional component
ICD-10: Q27.39 - Arteriovenous malformation, other site
(right scalp — AVM with ECA supply only)
Note
Confirm no intracranial component to the AVM before assigning 61626. If the AVM has both intracranial and extracranial supply embolized in the same session, consult current AMA guidance on whether to bill 61624 + 61626 or only 61624. Documentation of distinct vascular territories treated is essential.
Example 5 — Failed 31241, Same Admission, Escalation to IR
Clinical Scenario: Patient admitted inpatient for posterior epistaxis. ENT performs right SPA ligation (31241-RT) on Day 1. Patient rebleeds on Day 3. ENT and IR consult. Decision made to proceed with transcatheter embolization of the right internal maxillary artery. IR performs 61626 on Day 3.
Day 1 — ENT Claim:
CPT: 31241-RT - SPA ligation, right
ICD-10: R04.0, I10
Day 3 — IR Claim:
CPT: 61626-26-RT - Transcatheter permanent occlusion;
non-CNS head or neck; professional component
ICD-10: R04.0
T79.2xxD - Traumatic secondary and recurrent hemorrhage,
subsequent encounter
I10 - Essential hypertension
Note
Because 31241 has a 000-day global period, it does not conflict with billing 61626 on a separate date. Each is billed independently on its respective date of service. No cross-code bundling applies between CPT 31241 and CPT 61626 on different dates.
Example 6 — Same-Day Diagnostic Angiography and Embolization
Clinical Scenario: A new-onset posterior epistaxis patient is brought to IR with no prior angiographic evaluation. IR performs a diagnostic selective external carotid angiogram (medically necessary to identify the bleeding vessel and plan embolization) and then proceeds to transcatheter embolization of the identified bleeding vessel in the same session. The diagnostic angiography findings are separately documented (e.g., “angiography performed to identify source of posterior nasal hemorrhage; right sphenopalatine artery blush identified; therapeutic embolization then performed”).
CPT 1: 61626-26-RT - Therapeutic embolization, non-CNS head/neck
CPT 2: 36228-RT - Selective catheter placement, external carotid
artery (or 36217/36218 per vessel order)
(separately billable when diagnostic angio
performed and findings separately documented)
ICD-10: R04.0, I10
Note
The diagnostic angiography component (catheter placement + angiographic imaging) may be separately reported when a true diagnostic angiographic study was medically necessary in addition to the therapeutic embolization, and the diagnostic findings are independently documented. If only therapeutic-intent catheterization was performed (no separate diagnostic study), only 61626 is reported. Consult current NCCI edits for specific catheter placement code combinations.
Key Coding Pearls
- The single most important 2026 change: 75894 is GONE with 61626. Effective January 1, 2026, all RS&I is bundled into the 61626 procedure code. Any practice that continues to separately bill 75894 alongside 61626 after this date will receive denials and may face overpayment recoupment on audits. Update charge capture, chargemasters, and order sets immediately.
- 61626 is NOT inpatient-only; 61624 IS. This is a critical distinction for facility billing. If 61624 (CNS embolization) is performed in an outpatient hospital or ASC setting for a Medicare patient, it will be denied under the Medicare inpatient-only list. CPT 61626 does not carry this restriction and can be performed and billed in outpatient, ASC, and office settings.
- Modifier -26 is almost always required in a hospital setting. IR physicians performing 61626 at a hospital should virtually always append Modifier -26 to their professional claim. The hospital bills the technical component separately under OPPS. Failure to use -26 in a facility setting results in overbilling.
- Document CNS vs. non-CNS territory explicitly. The operative/procedure report must clearly state which artery was embolized and confirm it is in the extracranial/non-CNS territory. When treating a lesion with both CNS and non-CNS supply, each territory must be documented separately.
- Diagnostic angiography adds value when truly diagnostic. If a prior angiogram was performed (same day, same session) and its findings are separately documented as necessary to plan the embolization, catheter placement codes (36217, 36218) and diagnostic angiography codes may be additionally reportable. However, if the session was entirely therapeutic with no separate diagnostic study, only 61626 (and possibly catheter placement) is reported.
- Modifier -50 for bilateral embolization. Bilateral embolization in the same session (common in HHT or bilateral tumor supply) is reported with Modifier -50 or separate -LT/-RT line items per payer policy. Document each side’s vessel access, catheterization, and embolic deployment separately in the procedure note.
- 75898 (follow-up angiography) — verify 2026 status before billing. The AMA CPT Editorial Panel’s 2026 revisions and the HFMA 2026 fee schedule summary suggest 75898 may also be restricted or bundled in certain contexts with 61626. Consult your MAC’s local coverage policy and the most current AMA CPT parenthetical notes before billing 75898 with 61626.
- ICD-10-CM specificity is paramount for inpatient DRG optimization. For inpatient cases, complete coding of MCC-qualifying comorbidities (coagulopathy, significant blood loss anemia, malignancy) drives the shift from lower to higher-weighted DRGs, substantially impacting facility reimbursement.
- Moderate sedation: When the IR physician performing 61626 also administers moderate sedation, no separate sedation code is billed (it is considered part of the procedure). When a separate anesthesiologist or CRNA provides sedation or general anesthesia, they bill separately using their anesthesia codes. If a second qualified physician (not performing the procedure) provides moderate sedation, 99152/99153 may be separately billed.
- Not every embolization of a head/neck vessel is 61626. Review the vessel territory carefully. Vertebral artery embolization at or near its entrance into the skull base may cross into CNS territory (61624). Pulmonary or bronchial artery embolization for hemoptysis uses different peripheral vascular codes (37241-37244). Hepatic artery embolization (chemoembolization) uses 37243. Each anatomic territory has its own dedicated code family.