CPT Code 93922: A 2026 Guide to ABI and Vascular Study Billing

What is CPT code 93922 and how is it billed?

CPT code 93922 reports a limited bilateral noninvasive physiologic study of the extremity arteries, typically an ankle-brachial index (ABI) with Doppler waveforms and segmental pressures at one to two levels. It measures blood flow and pressure rather than producing an anatomical image, and it is payable only when a documented indication of peripheral arterial disease or vascular compromise supports medical necessity.

93922 versus 93923:
93922 covers a limited study of one to two levels; 93923 covers a complete study of three or more levels or a study with provocative maneuvers such as exercise.

Not a duplex ultrasound:
93922 uses Doppler but does not produce vessel images; a duplex arterial scan such as 93925 is the imaging study for lower extremity arteries.

The PAD diagnosis rule:
93922 is not covered as a screening test; it requires a qualifying indication such as claudication, non-healing ulcers, or diminished pulses documented in the record.

What Does CPT 93922 Cover?

CPT 93922 covers a limited bilateral noninvasive physiologic study of the extremity arteries at one to two levels. In podiatry practice that typically means an ankle-brachial index with Doppler waveform analysis and segmental blood pressure measurement at ankle and brachial sites. It quantifies blood flow and pressure rather than producing an anatomical image of the vessel.

The code is defined in the American Medical Association’s CPT code set within the noninvasive physiologic vascular study family (93922 through 93924). Because the code is physiologic, it is defined by what is measured and at how many levels, not by pictures of the vessel. That framing matters when distinguishing 93922 from the more extensive 93923 and from a true duplex imaging scan.

A typical 93922 study in a podiatry setting measures brachial and ankle systolic pressures, calculates the ABI (ratio of ankle to brachial pressure), and records Doppler waveforms at each site. Waveform morphology, in addition to the pressure ratio, helps identify the presence and severity of peripheral arterial disease. Levels beyond the ankle-brachial pair would move the study toward 93923.

Because 93922 is a physiologic study, calcified vessels can create artifactually high pressures and ABI values above 1.4 that mask disease. In diabetic patients especially, waveform analysis and toe-brachial index measurements can supplement or replace the ABI when calcification is suspected.

How Does 93922 Differ From 93923?

The two physiologic study codes split by extent. 93922 is a limited study of one to two levels, and 93923 is a complete study of three or more levels or a study that includes provocative functional maneuvers such as treadmill exercise or reactive hyperemia. The number of levels documented in the report determines which code applies.

The 93922 to 93923 boundary is a common source of both overbilling and undercoding. Reporting 93923 when only one or two levels were studied is an overbill and a target for audit recoupment. Reporting 93922 when a full three-level bilateral study with post-exercise pressures was performed leaves money on the table. The report is the authority; the code follows the report.

Code	Study type	Extent or levels	Report language to match
93922	Physiologic study (Doppler, pressures, waveforms)	Limited: one to two levels, bilateral	“Limited bilateral noninvasive physiologic study” or ABI with segmental pressures at 1-2 sites
93923	Physiologic study (Doppler, pressures, waveforms)	Complete: three or more levels, or with exercise or reactive hyperemia	“Complete bilateral noninvasive physiologic study” or study with post-exercise pressures
93925	Duplex ultrasound (imaging plus Doppler)	Bilateral lower extremity arterial duplex	“Complete bilateral lower extremity arterial duplex scan” with vessel images and flow

Is CPT 93922 an Ultrasound or a Duplex Scan?

93922 uses Doppler technology but is not a duplex imaging ultrasound. A duplex scan such as 93925 (complete bilateral lower extremity arterial duplex) combines real-time B-mode imaging with Doppler to show both the vessel wall and blood flow in the same study. 93922 records pressures and waveforms without producing that anatomical image.

The distinction matters both clinically and for coding. Physiologic studies like 93922 are strong at quantifying the physiologic impact of disease (pressure gradients, waveform morphology), but they cannot localize a specific lesion or show plaque or stenosis directly. Duplex studies like 93925 can localize lesions and show plaque, but they add cost and time and are typically ordered when the physiologic study or clinical picture points to a specific vessel that needs anatomic evaluation.

Because they are different study types, 93922 and 93925 are occasionally performed together, but National Correct Coding Initiative bundling edits frequently apply and payers expect a clear, separate medical necessity for each. Confirm the current NCCI edits for your date of service and document why both studies were clinically required before billing them on the same date.

The order of studies matters clinically. A physiologic study like 93922 typically comes first because it is faster and less expensive, and it screens for the presence and severity of disease. When the physiologic study identifies disease that needs anatomic localization for treatment planning, a duplex study follows. Ordering both simultaneously without that clinical logic often reads as a workup shortcut rather than a stepped evaluation, which is what triggers the bundling denials.

What Diagnosis Codes Support 93922?

The diagnosis codes that support 93922 are those establishing a clinical indication of peripheral arterial disease (PAD) or vascular compromise. Common ICD-10 codes include I73.9 for unspecified peripheral vascular disease, the I70.2 series for atherosclerosis of native arteries of the extremities with or without claudication, E11.51 for type 2 diabetes with diabetic peripheral angiopathy, and L97.4 or L97.5 for non-pressure chronic ulcers of the heel or foot.

The ICD-10-CM FY2026 edition (effective October 1, 2025 through September 30, 2026) keeps these code families in place. Specificity matters. A generic pain or edema code without a documented vascular indication does not establish medical necessity for a 93922 claim, and defaulting to unspecified PVD when a more specific code fits is a common source of medical-necessity denials.

For the unspecified PVD code most often paired with 93922, see our overview of ICD-10 code I73.9 for peripheral vascular disease. Use a more specific code whenever the record supports it: I70.213 for right leg claudication, E11.51 when diabetes is the driver, or L97.4x/L97.5x when a non-healing ulcer is the indication.

Traditional Medicare and most commercial payers publish coverage policies that list the covered diagnosis codes for 93922. Check the applicable Medicare Administrative Contractor local coverage determination or article, then map the referral diagnosis to the payer’s covered list before submitting the claim.

Why Is 93922 Denied When Billed as a Screen?

93922 is not covered as a routine screening test. Medicare and most commercial payers require a documented symptom or physical finding of peripheral arterial disease or vascular compromise before the study is payable. A physiologic arterial study ordered on an asymptomatic patient with no risk indication reads as a screen, and screening physiologic studies are denied.

The qualifying indications that support 93922 as medically necessary include:

• Documented intermittent claudication or exertional lower extremity pain relieved by rest.
• Rest pain or ischemic pain at rest, particularly nocturnal foot pain relieved by dependency.
• Non-healing ulcers of the foot or lower leg, or wounds that fail to progress despite standard care.
• Diminished or absent pedal pulses, delayed capillary refill, or other exam findings suggesting arterial compromise.
• Diabetic patients with signs or symptoms of peripheral vascular disease, including neuropathic changes with vascular concerns.
• Pre-operative vascular assessment when a planned procedure creates specific vascular risk that must be documented.

Providers often come to us after a wave of 93922 denials where the study itself was appropriate but the referring provider’s note documented "vascular check" or "circulation assessment" without naming an indication. The claim then codes to an unspecified diagnosis that does not clear medical necessity. The fix is upstream at the order and referral note, not at the claim scrubber.

What Documentation Does 93922 Require?

93922 must be performed with appropriate equipment and qualified personnel, and it requires a formal interpretation and written report to be billable. The interpretive report is not optional; a study performed without a separate, signed interpretive report is not payable regardless of how well the technical component was performed.

Payer auditors look for a distinct interpretive document, not a line or two appended to the encounter note. The report has to stand on its own as the physician’s interpretation of the vascular study, separate from the visit note that documents the clinical decision to order the test.

Every 93922 report should include:

• The clinical indication for the study, tied to a documented symptom or physical finding rather than a generic vascular check.
• The methods and levels studied, including which pressures were measured, at which sites, and how waveforms were captured.
• The measured values, including brachial and ankle systolic pressures and the calculated ABI for each side.
• The interpreting provider’s findings, including waveform morphology and the assessment of arterial patency.
• A written conclusion with clinical correlation and, when appropriate, recommendations for further evaluation.

For a broader reference on documentation standards across common podiatry codes, see our podiatry billing and coding cheat sheet.

How Much Does Medicare Pay for 93922 in 2026?

Medicare publishes an annual allowance for 93922 in the Medicare Physician Fee Schedule, adjusted by locality and split between the professional (modifier 26) and technical (modifier TC) components when the two are billed separately. The specific 2026 amount varies by MAC region and by whether the practice bills the global service or a component only. Refer to the current CMS 2026 fee schedule for the number in your locality.

Because 93922 requires both technical performance and a formal interpretation, many podiatry practices bill the global service under the same NPI when the physician performs the interpretation on equipment the practice owns. Practices that send interpretations to an outside reader split the components with modifier 26 for the professional side and modifier TC for the technical side.

One question we hear constantly from podiatry practice managers is how often the 93922 allowance is worth the operational overhead of running the study in-house. The answer usually depends on volume and on how well the diagnosis capture and interpretive report workflow are built. Practices with a steady stream of symptomatic diabetic and PAD-risk patients typically capture the allowance cleanly. Practices that run the study only occasionally often lose it to documentation gaps, which is where fee-schedule math starts working against them.

Why Do 93922 Claims Get Denied?

The most common 93922 denials trace back to six patterns: a diagnosis that does not establish medical necessity, screening framing without a qualifying indication, a missing or incomplete interpretive report, the wrong code chosen between 93922, 93923, or a duplex study, bundling conflicts with other vascular services on the same date, and payer-specific frequency limits. Every pattern is preventable before the claim goes out.

• Diagnosis mismatch, where the ICD-10 code does not appear on the payer coverage list for 93922.
• Screening framing, where the referral note reads as a routine vascular check with no symptom or physical finding documented.
• Missing or incomplete interpretive report, where the study values were recorded but no signed interpretation was generated.
• Wrong code selected, where 93923 was billed for a one-to-two-level study or 93922 was billed for a full three-level study with exercise pressures.
• Bundling conflicts, where 93922 was billed alongside a duplex or another physiologic study on the same date without documented separate medical necessity.
• Frequency limits exceeded, where a repeat 93922 was billed within a payer-defined lookback window without documented clinical change.

Across the billing companies we vet, the highest-yield fix on a 93922 denial pattern is a pre-submission scrub that verifies the indication in the referral, confirms a covered ICD-10 diagnosis on the claim, and validates that the interpretive report is complete. That check catches four of the six denial patterns before submission and shifts the remaining two into a workable appeal position.

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