CPT Code for Bilateral Renal Arteriogram: A Complete Billing Guide

If you are reading this, you have probably spent way too much time searching through your CPT manual. You have a report for a bilateral renal arteriogram, and you just want a clear, honest answer about which code to use.

You are not alone. Renal artery imaging is common, but the coding rules can feel confusing. Does “bilateral” mean you use a single code? Do you add a modifier? What if the doctor only looks at one side?

Let us walk through this together. By the end of this guide, you will know exactly which code to choose, how to document it, and how to avoid a denial.

What Is a Bilateral Renal Arteriogram?

Before we talk about codes, let us quickly define the procedure. A renal arteriogram is an X-ray exam of the renal arteries. These are the blood vessels that carry blood to your kidneys.

The doctor injects a contrast dye through a catheter. Then they take live X-ray images (fluoroscopy) to see if there are any blockages, narrowings (stenosis), aneurysms, or other problems.

When the procedure is bilateral, it means the doctor examines the arteries for both kidneys: the right and the left.

Sometimes the doctor only does one side. That is a unilateral study. Other times, they look at both. That is bilateral.

The Short Answer: Which CPT Code for Bilateral Renal Arteriogram?

Here is the direct answer you came for.

The correct CPT code for a diagnostic bilateral renal arteriogram is:

CPT 36245

But there is a catch. You must read carefully.

CPT 36245 is officially described as: Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family.

In plain English: this code covers selective catheter placement into a first-order branch of the abdominal aorta. The renal arteries qualify as first-order branches.

However, 36245 is a unilateral code. That means it represents one artery.

So if the doctor does a bilateral study (right and left renal arteries), you typically report 36245 with modifier 50.

Correct billing for bilateral renal arteriogram: CPT 36245-50

Alternatively, some payers prefer two units of 36245 with modifier RT and LT. We will cover those differences below.

Understanding the Vascular Family Concept

This is where many coders get lost. The CPT manual organizes arteries into “vascular families.”

A vascular family starts at the aorta. The first vessel that branches off is a first-order branch. The renal arteries are first-order branches of the abdominal aorta.

Here is a simple breakdown:

For a standard bilateral renal arteriogram, the catheter goes into the main renal artery on each side. That is first-order. So 36245 is your code.

Bilateral Coding: Modifier 50 vs. RT and LT

Now let us talk about how to show “both sides” on your claim.

You have two correct options. Which one you choose depends on the payer.

Option 1: Modifier 50 (Bilateral Procedure)

This is the most common method for Medicare and many commercial payers.

You report 36245-50 once. The payment is typically 150% of the unilateral fee (100% for the first side, 50% for the second).

Example:

• CPT code: 36245

• Modifier: 50

Option 2: Modifier RT and LT

Some payers want you to report two line items. On one line, you put 36245-RT (right side). On the second line, you put 36245-LT (left side).

Example:

• Line 1: 36245-RT

• Line 2: 36245-LT

Some payers will pay 100% for each line. Others may reduce the second line. Always check your local payer policy.

Important note: Never report 36245-50 and also two separate lines. That is double billing and will get denied or audited.

When Not to Use 36245 for a Bilateral Renal Arteriogram

There are situations where 36245 is not the right choice. Let us look at the most common exceptions.

1. Non-Selective Injection (Aortogram)

If the doctor does not place the catheter into the renal artery itself. Instead, they inject dye into the aorta and let it flow into the renal arteries. That is not selective.

For a non-selective bilateral renal study, you would use:

• CPT 36200 (Catheter placement in the aorta)

You would then report the imaging portion separately if performed. But for a simple aortogram with renal runoff, 36200 is the code.

2. The Procedure Is Therapeutic, Not Diagnostic

If the doctor performs an angioplasty, stenting, or atherectomy on the renal arteries, you do not use 36245 alone.

You will use a different set of codes:

• 37236 for renal artery stent placement (per vessel)

• 35471 for renal angioplasty (older codes may apply, check your manual)

For a bilateral therapeutic procedure, you would add modifier 50 or RT/LT to the intervention code.

3. Superselective (Third-Order or Beyond)

If the doctor goes deep into a segmental branch of the renal artery, that is no longer first-order. You would use 36247 instead.

For bilateral superselective, you would use 36247-50 or two units of 36247.

Step-by-Step: How to Find the Correct Code in Your CPT Manual

Let us walk through the logic together. This will help you feel confident next time.

1. Identify the vessel: Renal artery.

2. Determine the order: Main renal artery is first-order abdominal branch.

3. Check selective vs. non-selective: Did the catheter go into the renal artery? Yes = selective. No = non-selective.

4. Locate the vascular family section: CPT codes 36145–36253 cover arterial catheterization.

5. Find first-order abdominal branch code: That is 36245.

6. Determine laterality: Bilateral.

7. Apply modifier: Modifier 50 or RT/LT.

That is it. No magic. No secret code. Just logic.

Documentation Requirements for Bilateral Renal Arteriogram

Your coding is only as good as your documentation. If the report does not say “bilateral,” you cannot code bilateral.

Here is what your provider’s note must include to support a bilateral code:

• A clear statement that both renal arteries were selectively catheterized.

• Separate descriptions of the right and left findings.

• Fluoroscopy times for each side (if required by your payer).

• Contrast type and amount.

If the doctor writes “renal arteriogram” without specifying laterality, you must assume unilateral. Query the provider if you are unsure.

Real-world tip: Many coders receive reports that say “bilateral renal arteriogram” in the procedure name, but the body of the note only describes one side. That is not enough. Always read the full report.

Billing for Renal Arteriogram with Other Procedures

What if the doctor does a bilateral renal arteriogram and also images the iliac arteries or the aorta?

You have to follow the “vascular family” bundling rules.

If the doctor accesses the same vascular family, you cannot code for each separate poke. The CPT rules say that catheter placements in the same family are bundled.

Here is a common scenario:

• Aortogram (36200)

• Bilateral selective renal arteriogram (36245-50)

Can you bill both? Usually no. The selective renal study includes the aortogram if performed in the same session. Most payers consider 36200 as part of the selective work.

But there is an exception. If the aortogram was medically necessary for a different reason (like evaluating a AAA), you may append modifier 59. However, that is rare. When in doubt, bundle.

Medicare and Payer-Specific Rules

Medicare has specific guidelines for renal arteriography. They follow the National Correct Coding Initiative (NCCI).

As of 2025 and into 2026, Medicare’s NCCI edits bundle non-selective aortography (36200) into selective renal angiography (36245). You cannot bill both unless there is a separate indication with a modifier.

Medicare also accepts modifier 50 for bilateral renal arteriograms. They reimburse at 150% of the unilateral rate.

Some MACs (Medicare Administrative Contractors) require documentation of medical necessity for bilateral studies. If the patient only has one kidney, bilateral is not appropriate. That would be a denial.

Always check your local MAC’s LCD (Local Coverage Determination) for renal angiography.

Common Billing Mistakes to Avoid

Let us save you from the most frequent errors we see.

Examples from Real Coding Scenarios

Let us make this practical. Here are three common patient stories.

Example 1: Routine Bilateral Study

Procedure note: “Selective catheterization of the right main renal artery. Images obtained. Then selective catheterization of the left main renal artery. Images obtained. Findings: mild right renal stenosis, left normal.”

Correct coding: 36245-50

Example 2: Unilateral Only

Procedure note: “Selective catheterization of the right renal artery. The left renal artery was not engaged due to patient discomfort.”

Correct coding: 36245-RT

Example 3: Bilateral with Aortogram

Procedure note: “Non-selective aortogram performed to assess for AAA. Then selective catheterization of both renal arteries.”

Correct coding: 36245-50 only. Do not add 36200.

How to Handle Denials for Bilateral Renal Arteriogram

Sometimes even when you code correctly, payers deny. Here is what to do.

Denial reason: “Bilateral procedure not supported”

• Check the note. Does it say “bilateral” explicitly? If yes, appeal with the note.

• If no, ask for an addendum.

Denial reason: “Missing modifier”

• Some payers want -50. Others want -RT and -LT. Resubmit with the correct modifier format for that payer.

Denial reason: “Medically unnecessary”

• This often happens if the patient has a single kidney or no symptoms on one side. Review the medical necessity documentation. If it is solid, write an appeal letter.

Tips for Clean Claims

Here is a quick checklist before you submit:

• Procedure is selective, not non-selective.

• Catheter is in the main renal artery (first-order).

• Documentation clearly says “bilateral” or describes both sides.

• Modifier 50 or RT/LT is present.

• No unbundled aortogram code (36200) on the same claim.

• Medical necessity is documented for both sides.

What About Imaging Supervision and Interpretation?

This article focuses on the catheter placement code (36245). But a renal arteriogram also includes the radiology portion.

Typically, the same physician who places the catheter also supervises and interprets the images. In that case, you do not need a separate code for interpretation. It is included in 36245.

However, if a different physician interprets the images, that physician would report:

• CPT 75625 (Aortography, renal runoff) or

• CPT 75630 (Abdominal aortography with bilateral iliofemoral runoff)

But for a standard selective bilateral renal arteriogram with same-provider read, 36245 covers the entire service.

Medicare’s 2026 Perspective

As of April 2026, no major changes have been made to the renal angiography codes. The CPT manual remains stable for 36245, 36246, and 36247.

The only shift we are seeing is increased auditing for medical necessity on bilateral studies. Payers want to know: why both sides? If the patient has unilateral symptoms, why image the other side?

Your best defense is a strong note. The provider should explain, for example: “Contralateral imaging performed to rule out asymptomatic stenosis due to patient’s history of uncontrolled hypertension.”

Frequently Asked Questions (FAQ)

1. Can I use 36245 for a bilateral renal arteriogram if the patient has only one kidney?

No. Bilateral means two sides. If the patient has one kidney, you code unilateral (36245-RT or LT). Using modifier 50 would be incorrect.

2. What is the difference between 36245 and 36247 for the kidney?

36245 is for the main renal artery. 36247 is for a segmental branch (third-order) inside the kidney. Most renal arteriograms are 36245.

3. Does Medicare pay more for bilateral?

Yes. With modifier 50, Medicare pays 150% of the unilateral rate. For example, if 36245 pays $200, bilateral pays $300.

4. What if the doctor does the right renal artery, then the left, then goes back to the right?

Still bilateral. You do not count each engagement. You code based on the vessels studied, not the number of catheter movements.

5. Is there a specific CPT code for “bilateral renal arteriogram” without a modifier?

No. There is no single code that says “bilateral” in the descriptor. You must use a unilateral code plus a bilateral modifier.

6. What if the doctor attempts both sides but only succeeds on one?

Code for what was performed. If only the right was successfully imaged, code 36245-RT. Do not use modifier 50.

Additional Resource

For the most current Medicare payment rates and Local Coverage Determinations for renal angiography, visit the CMS.gov Physician Fee Schedule Look-up Tool.

You can also refer to the American College of Radiology (ACR) Appropriateness Criteria for renovascular hypertension. That document helps justify medical necessity for bilateral studies.

👉 [CMS Physician Fee Schedule Search (Direct link for reference)]

Final Conclusion

To summarize this guide in three lines:

A bilateral renal arteriogram is coded with CPT 36245 plus modifier 50 (or RT/LT depending on the payer). The key is ensuring the documentation clearly states both renal arteries were selectively catheterized. Avoid common errors like unbundling aortography or using superselective codes for main renal artery studies.

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Disclaimer: This article is for educational purposes only. Medical coding rules change frequently, and payer policies vary. Always verify codes with your current CPT manual and local payer guidelines. This information does not constitute legal or billing advice.