CPT Code Description

93880 Duplex scan of extracranial arteries; complete bilateral study

Duplex scanning of arteries for the evaluation of blood flow is a type of non–invasive vascular diagnostic process. A physician can visualize and selectively assess the flow patterns of peripheral vessels using real–time ultrasound imaging and pulsed Doppler. The presence of arterial stenosis, occlusion, and identification of incompetent veins can also be achieved through this process.

93985 Non-Invasive Extremity Arterial-Venous Studies

The provider performs a duplex ultrasound scan of the arteries and veins in both upper extremities to assess vascular supply and venous return in the arm prior to establishing hemodialysis access.


Noninvasive tests of carotid function aid physicians in studying and diagnosing carotid disease. There are varieties of these tests which measure various physiological and anatomical aspects of carotid function, including pressure (systolic, diastolic, and pulse), turbulence, flow, and collateral circulation.

It is useful to classify noninvasive tests of carotid function into direct and indirect tests. The direct tests examine the anatomy and physiology of the carotid artery, while the indirect tests examine hemodynamic changes in the distal beds of the carotid artery (the orbital and cerebral circulations).

It is important to note that the names of these tests are not standardized. Following are some of the tests, this list is not inclusive and that local medical consultants should make determinations:

Direct Tests

  • Carotid Phonoangiography
  • Ultrasound Imaging including Real Time
  • B-Scan and Doppler Devices
  • Spectral Bruit Analysis
  • Direct Bruit Analysis
  • Doppler Flow Velocity

Indirect Tests

  • Periorbital Directional Doppler Ultrasonography
  • Ophthalmodynamometry
  • Oculoplethysmography

Nationally Non-Covered Indications:

Compliance with the provisions in this policy is subject to monitoring by post payment data analysis and subsequent medical review. Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states ” …no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis and treatment of illness or injury…”. Furthermore, it has been longstanding CMS policy that “tests that are performed in the absence of signs, symptoms, complaints, or personal history of disease or injury are not covered unless explicitly authorized by statute”.

The authors compare computed tomography (CT)

scans and color duplex ultrasonography in the evaluation of common carotid artery atherosclerotic lesions.
Duplex ultrasound evaluation of the extracranial carotid artery is reported through two discrete coding descriptions. CPT code 93880 describes a “complete bilateral” study that generally involves cross sectional evaluation of the plaque for morphology and luminal compromise as well as Doppler spectral analysis with velocity measurements of the blood flow at several locations. The absolute measurements at peak systole and end diastole combined with the ratio of internal carotid to common carotid artery velocities are used through validated criteria to help determine degree of stenosis. When the evaluation based on the validated institutional requirements is satisfactory on both sides of the neck, the study may be classified as “bilateral and complete” for reporting purposes. Under certain circumstances, a limited or unilateral study may be appropriate. CPT code 93882 conveys this less work intensive ultrasound procedure. Remember that a bilateral study which is not complete (i.e., limited) would be classified by CPT code 93882.

Cerebrovascular Arterial Studies (93880-93893)

  • 93880 Duplex scan of extracranial arteries; complete bilateral study
  • 93895 Quantitative carotid intima media thickness
    and carotid atheroma evaluation, bilateral
  • (Do not report 93895 in conjunction with 93880, 93882, 0126T)
  • National Government Services (NGS)
  • MAC for CT, IL, ME, MA, MN, NH, NY, RI, VT & WI
  • Any combination of 93880, 93882 with 93970, 93971, 93925 and 93926 will result in denial of all claims even if otherwise within LCD identified ICD parameters for medical necessity
  • All denied claims must be appealed for medical review
  • Blue Cross / Blue Shield of Massachusetts
  • Effective 9/1/15, ALL endovenous ablations must be performed in IAC accredited Vein Centers
  • Catch 22: precisely ONE IAC accredited Vein Center exists in the entire state

Non-Invasive Vascular Studies

For evaluation of carotid arteries, use CPT codes 93880, duplex scan of extracranial arteries, complete bilateral study or 93882, unilateral or limited study.
To report a transcranial Doppler study (TCD), use CPT codes 93886 and 93888. Explanatory Notes in CPT regarding transcranial Doppler studies indicate the following: “A complete transcranial Doppler study includes evaluation of the right and left anterior circulation territories and the posterior circulation territory
(to include vertebral arteries and basilar artery). In a limited TCD study (93888) there is ultrasound evaluation of two or fewer of these territories”

For evaluation of extremity veins for venous incompetence or deep vein thrombosis, use CPT codes 93970, duplex scan of extremity veins; complete bilateral study or 93971, unilateral or limited study.

Medicare has created code G0365 to be used for vessel mapping performed in conjunction with the creation of an autogenous hstula for hemodialysis access. The code includes evaluation of the relevant arterial and venous vessels.

The limited venous extremity code (93971) is used for all other vein mapping. Check with your payers for coverage guidelines on this procedure. In some cases it is not paid in the absence of a previous condition such as severe varicose veins or previous deep vein thrombosis.

To evaluate the functioning of an existing hemodialysis graft or fistula, use CPT code 93990. Medicare has published specific coverage guidelines for this procedure – review the Local Coverage Determination for specifics.

CPT Code CPT Code Descriptor Global Payment Professional Payment Technical Payment APC Code APC Payment
93880 Duplex scan of extracranial arteries; complete bilateral study $192.01 $30.45 $161.56 0267 $190.84

Cerebrovascular Arterial Studies

Extracranial Arterial Studies (93880-93882)

Covered cerebrovascular arterial study testing methods include (real-time) duplex scans; and Doppler ultrasound waveform with spectral analysis.
Non-covered/non-reimbursed methods include testing methods that have not been found to be useful based on authoritative technological assessments or that are included as part of the physical examination.

Cerebrovascular arterial studies may be considered medically necessary if one or more of the following signs and symptoms are present:

• Asymptomatic or symptomatic cervical bruits;
• Amaurosis fugax;
• Focal cerebral or ocular transient ischemic attacks (including but not limited to):
? localizing symptoms, e.g., sensory loss; and/or
? weakness of one side of the face; and/or
? slurred speech; and/or
? weakness of a limb;
• Syncope that is strongly suggestive of vertebrobasilar or bilateral carotid artery disease in etiology, as suggested by medical history;
• Recent history of a previous neurologic or cerebrovascular event;
• Before major cardiac and vascular surgery when a bruit is noted or there is a history of previous neurologic or cerebrovascular event;
• After carotid endarterectomy (outside the global period), or follow-up of previously documented stenoses;
• Pulsatile neck mass;
• Evaluation of blunt or penetrating neck trauma;
• Ocular microembolism (optic nerve/retinal arterial-Hollenhorst plaques/ocular);

Limitations: Studies may not be considered medically necessary if performed for the following signs and symptoms:


PVD-3.1: Initial Imaging

  • Duplex ultrasound (CPT® 93880 bilateral or CPT® 93882 unilateral), prior to considering advanced imaging, can be used to evaluate possible carotid artery
    disease when ANY of the following apply:
  • Hemispheric neurologic symptoms including stroke, TIA, or amaurosis fugax
  • Non-hemispheric or unexplained neurologic symptoms
  • Known or suspected retinal arterial emboli or Hollenhorst plaque
  • Suspected carotid dissection
  • Pulsatile neck masses
  • Carotid or cervical bruit
  • Abnormal findings on physical exam of the carotid arteries (e.g. aneurysm or absent carotid pulses)
  • Preoperative evaluation of individuals with evidence of severe diffuse atherosclerosis, scheduled for major cardiovascular surgical procedures
  • Preoperative evaluation of individuals prior to elective coronary artery bypass graft (CABG) surgery in individuals older than 65 years of age and in those with
    peripheral artery disease, history of cigarette smoking, history of stroke or TIA, or carotid bruit
  • Suspected Subclavian Steal Syndrome
  • See CH-27: Subclavian Steal Syndrome in the Chest Imaging Guidelines
  • Blunt neck trauma
  • Vasculitis potentially involving carotid arteries
  • Carotid ultrasound screening in asymptomatic individuals due only to risk factors is not indicated
  • New signs and symptoms consistent with carotid artery disease (e.g. TIA, amaurosis fugax, change in nature of a carotid bruit) are an indication to re-image the cervical vessels (regardless of when the previous carotid imaging was performed) using ANY of the following:
  • Duplex ultrasound (CPT® 93880 bilateral study or CPT® 93882 unilateral study),
  • MRA Neck with contrast (CPT® 70548),
  • CTA Neck (CPT® 70498).
  • MRA Neck with contrast (CPT® 70548) or CTA Neck (CPT® 70498) can be performed if duplex Ultrasound shows =/> 70% occlusion/stenosis of the internal carotid artery.
  • MRA Head (CPT® 70544) or CTA Head (CPT® 70496) can be added if carotid intervention is planned.
  • MRA Neck (CPT® 70548) or CTA Neck (CPT® 70498) can be performed if ultrasound findings suggest ulcerated plaque.
  • Surveillance imaging once a year for individuals with fibromuscular dysplasia of the extracranial carotid arteries.
  • For follow-up imaging of known carotid disease See PVD-3.2: Surveillance Imaging with NO History of Carotid Surgery or Intervention.

Duplex Scan (93880-93882);


  • Non-invasive Physiologic Studies (CPT codes 93875-93882)
    CPT-4 93875 will not be reimbursed in addition to a Duplex study without supporting documentation establishing the medical necessity for additional studies. (Doppler ultrasound/spectrum analyses are included in the duplex scan. OPG may be useful in confirming carotid stenosis greater than 50%, or evaluation of postoperative neurological symptoms.
    Each code used for carotid studies represents a battery of tests. Only one unit of service may be billed per day even if more than one individual test falling within each code is performed the same day.
    Since Duplex scanning of the carotid vessels is considered to be the most useful test for surgically correctable occlusive disease, only it (93880 or 93882) will generally be reimbursed.
    Separate vertebral artery studies are rarely indicated, and will not be considered for reimbursement without additional justification of medical necessity. This could consist of specific symptomatology for patients in which other non-vascular conditions have been ruled out and for which there are no contraindications to the

The following limitations apply to multiple non-invasive studies on the same encounter or same day:
A. Performance of both non-invasive extracranial arterial studies (CPT codes 93880 or 93882) and non-invasive evaluation of extremity veins (CPT codes 93970 or 93971)
during the same encounter is rarely medically necessary. Documentation must clearly support the medical necessity if both procedures are performed during the same encounter, and be made available upon request.

B. Because 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 is rarely medically necessary. Consequently, documentation must clearly support the medical necessity of both procedures if performed during the same encounter, and be made available upon request.

C. It is rarely medically necessary to perform lower extremity and upper extremity studies on the same day. Documentation must clearly support the medical necessity of both upper and lower extremities if performed on the same day, and be made available upon request.

Documentation Requirements

  1. All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record should support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code should describe the service performed.
  4. The medical record documentation must support the medical necessity of the services as directed in this policy.
  5. The medical necessity for performing both non-invasive extracranial arterial studies (CPT codes 93880 or 93882) and non-invasive evaluation of extremity veins (CPT codes 93970 or 93971) during the same encounter must be clearly documented in the medical record.
  6. The medical necessity for performing simultaneous arterial and venous studies during the same encounter must be clearly documented in the medical record.
  7. The medical necessity of performing lower extremity and upper extremity studies on the same day must be clearly documented in the medical record.

Conditions of Coverage
Reimbursement is dependent on, but not limited to, submitting Ohio Medicaid approved CPT and/or HCPCS codes and the appropriate modifiers, if applicable. The appropriate ICD-10 diagnosis code must match the correct CPT and/or HCPCS code within this policy Please refer to the Ohio Medicaid fee schedule for appropriate codes

CPT Code Description
93880 Duplex scan of extracranial arteries; complete bilateral study