5 Essential Ankle Brachial Index CPT Code Facts Every Physician Must Know

The ankle brachial index CPT code is the billing identifier physicians use to report noninvasive vascular studies that measure blood flow in the lower extremities. Understanding the difference between CPT codes 93922 and 93923 is essential for accurate reimbursement, proper documentation, and streamlined practice management. Whether you are a physician adding peripheral arterial disease (PAD) testing to your practice or a billing specialist ensuring clean claims, this guide breaks down everything you need to know about ankle brachial index CPT codes.

What Is an Ankle Brachial Index Test and Why Does It Matter?

An ankle brachial index (ABI) test is a noninvasive diagnostic procedure that compares blood pressure readings at the ankle with readings at the arm. The test identifies peripheral artery disease by revealing reduced blood flow to the lower extremities. During the procedure, a clinician wraps blood pressure cuffs around the patient’s arms and ankles, then uses a Doppler ultrasound probe to capture arterial pressure waveforms at each site.

The ABI ratio is calculated by dividing the highest ankle systolic pressure by the highest brachial systolic pressure. A normal ABI falls between 1.0 and 1.4. Values below 0.9 indicate peripheral artery disease, while values above 1.4 may suggest arterial calcification. According to the American Heart Association, an abnormal ABI is associated with increased cardiovascular morbidity and mortality, making timely evaluation important for at-risk patients.

For independent physician practices, ABI testing is a useful in-house diagnostic service. The test takes only 7 to 10 minutes, requires minimal consumable costs, and may be covered by Medicare and most commercial payers when medically necessary. Devices like the CMAT Advantage™ from HealthWright Technologies streamline ABI testing by combining ankle brachial index measurement with additional autonomic nervous system measurements in a single platform built on FDA-cleared component devices.

What Is CPT Code 93922 for Ankle Brachial Index?

CPT code 93922 describes a limited bilateral noninvasive physiologic study of upper or lower extremity arteries. This code applies when the physician performs testing at one or two levels on both sides of the body. The study includes ankle and brachial pressure measurements, Doppler waveform analysis, and volume plethysmography.

Official CPT 93922 code description: the American Medical Association defines 93922 as “limited bilateral noninvasive physiologic studies of upper or lower extremity arteries.” For the lower extremity, that descriptor covers ankle/brachial indices at the distal posterior tibial and anterior tibial (dorsalis pedis) arteries plus bidirectional Doppler waveform recording and analysis at 1–2 levels, or the same indices with volume plethysmography at 1–2 levels. In plain terms, the 93922 description is a resting, limited ABI study performed at no more than two levels per side — which is exactly how most resting ABI studies are coded.

Practices use the 93922 ankle brachial index CPT code when performing a straightforward resting ABI study without exercise provocation or segmental pressure measurements beyond two levels. Common clinical scenarios for 93922 include evaluating diabetic patients with risk factors or symptoms of PAD, post-procedural surveillance after peripheral vascular intervention, and cardiovascular evaluation in symptomatic or at-risk patients.

Documentation requirements for CPT 93922 include recording bilateral pressure measurements, Doppler waveform tracings, calculated ABI ratios, and a written interpretation by the supervising physician. The medical record must support the medical necessity of the study with appropriate diagnosis codes.

What Is the Difference Between CPT Code 93922 and 93923?

CPT code 93923 describes a complete bilateral noninvasive physiologic study of upper or lower extremity arteries at three or more levels, or with provocative functional maneuvers. This code represents a more comprehensive evaluation than 93922 and carries a higher reimbursement rate.

The key distinctions between these two ankle brachial index CPT codes are:

• 93922 (Limited): Testing at 1-2 levels bilaterally, resting study only, basic ABI with Doppler waveforms
• 93923 (Complete): Testing at 3+ levels bilaterally, may include exercise or provocative maneuvers, segmental pressures throughout the leg

Segmental pressure measurements in CPT 93923 involve placing cuffs at the high thigh, above the knee, below the knee, and at the ankle. This approach pinpoints the exact location of arterial stenosis. Exercise testing, such as treadmill walking followed by immediate post-exercise ABI measurements, further reveals hemodynamically significant disease that may not appear at rest.

Physicians should never bill both 93922 and 93923 on the same date of service for the same patient. Medicare considers these codes mutually exclusive, and submitting both will result in a claim denial.

A third related code, CPT 93924, applies specifically to lower-extremity arterial studies performed at rest and after treadmill stress testing. It is reserved for that exercise-based protocol rather than a standard resting ABI, so most independent practices evaluating for PAD will report 93922 or 93923 rather than 93924.

How Does Medicare Reimbursement Work for ABI CPT Codes?

Medicare reimburses ABI testing under the Physician Fee Schedule based on the CPT code submitted. Reimbursement for CPT 93922 varies by geographic locality, with adjustments based on the Medicare conversion factor and the relative value units (RVUs) assigned to the code. CPT 93923 carries higher RVUs and correspondingly higher reimbursement due to the additional complexity of the study. Coverage and allowable amounts vary by payer, so verify current rates with each payer before billing.

For practices using multi-parameter devices like the CMAT Advantage™, a single encounter can document more than the ABI alone. The CMAT Advantage performs ABI testing alongside heart rate variability analysis (CPT 95921) and sudomotor and autonomic function testing (CPT 95923), so a clinically indicated encounter can support multiple clinically distinct CPT codes from a single patient encounter when each test is medically necessary and documented.

Proper documentation of medical necessity is essential. Tests performed without documented signs, symptoms, or risk factors may be denied as not medically necessary. The HealthWright Technologies partnership program includes billing guidance and documentation support to help practices submit clean claims.

Which ICD-10 Diagnosis Codes Support ABI Testing?

Pairing the correct ICD-10 diagnosis code with your ankle brachial index CPT code is critical for claim approval. The most commonly used diagnosis codes for ABI testing include:

• I70.211: Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
• I70.212: Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
• I70.213: Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
• I73.9: Peripheral vascular disease, unspecified
• E11.51: Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
• R60.0: Localized edema (when evaluating lower extremity swelling)

The diagnosis code must reflect the clinical reason for ordering the test. Claims submitted with vague or unsupported diagnosis codes face higher denial rates. Documenting the patient’s presenting symptoms, relevant medical history, and clinical findings in the encounter note strengthens the medical necessity justification.

What Documentation Is Required for ABI Billing Compliance?

Accurate documentation is the foundation of compliant ABI billing. For both the 93922 and 93923 ankle brachial index CPT codes, the medical record must include:

• Order from the referring or treating physician with clinical indication
• Bilateral pressure measurements at each tested level
• Doppler waveform tracings for each tested site
• Calculated ABI ratios with interpretation
• Written physician interpretation and report
• Proof of medical necessity linked to appropriate ICD-10 codes

Common documentation errors that lead to claim denials include failing to record bilateral measurements, omitting the physician interpretation, and using the wrong CPT code relative to the number of levels tested. Practices that invest in structured documentation workflows, such as those provided through the CMAT Advantage implementation program, significantly reduce denial rates and improve clean-claim performance.

How Can Practices Streamline ABI Testing and Billing?

Implementing ABI testing as an in-house diagnostic service requires the right combination of clinical technology, staff training, and billing infrastructure. The CMAT Advantage™ system from HealthWright Technologies addresses all three with a platform built on FDA-cleared component devices, with built-in clinical decision support, automated report generation, and dedicated billing guidance.

The CMAT Advantage measures ankle brachial index alongside autonomic nervous system biomarkers in a single 7-to-10-minute test. This multi-parameter approach improves clinical insight into cardiovascular and peripheral vascular risk and supports multiple clinically distinct CPT codes from one session, each separately coded when medically necessary and documented.

For practices considering adding vascular diagnostics, contact HealthWright Technologies to learn how the CMAT Advantage can integrate into your existing workflow with full training, implementation support, and ongoing billing assistance.

Frequently Asked Questions About Ankle Brachial Index CPT Codes

What is the CPT code for an ankle brachial index test?

The primary ankle brachial index CPT code is 93922 for a limited bilateral study at 1-2 levels, or 93923 for a complete bilateral study at 3 or more levels with optional exercise testing. The correct code depends on the number of measurement levels and whether provocative maneuvers were performed.

What is the CPT 93922 code description?

The official CPT 93922 code description is “limited bilateral noninvasive physiologic studies of upper or lower extremity arteries.” For lower-extremity PAD testing, it covers ankle/brachial indices with bidirectional Doppler waveform recording or volume plethysmography at one to two levels per side, performed at rest. A more extensive study at three or more levels, or one that adds exercise (treadmill) testing, is reported with 93923 instead.

Can you bill CPT 93922 and 93923 on the same day?

No. CPT codes 93922 and 93923 are mutually exclusive and cannot be billed together on the same date of service for the same patient. If a limited study is upgraded to a complete study during the same encounter, only the complete study code (93923) should be submitted.

What is the Medicare reimbursement for ABI testing?

Medicare reimbursement for CPT 93922 varies by geographic locality and the Medicare conversion factor and RVUs assigned to the code. CPT 93923 carries higher reimbursement due to the increased complexity. Practices using multi-parameter devices like the CMAT Advantage can support additional CPT codes (95921, 95923) from the same encounter when each test is medically necessary and documented. Coverage and allowable amounts vary by payer.

Does Medicare cover ABI screening for asymptomatic patients?

Medicare generally does not cover ABI screening performed without documented clinical indications. The test must be ordered as a diagnostic study supported by signs, symptoms, or established risk factors such as diabetes, claudication, or known peripheral vascular disease. Proper ICD-10 coding is essential for claim approval.

What is the difference between ABI and segmental pressures?

An ABI measures blood pressure at one level (the ankle) compared to the arm. Segmental pressures measure blood pressure at multiple levels along the leg (high thigh, above knee, below knee, ankle) to localize the site of arterial obstruction. A basic ABI study is billed under CPT 93922, while segmental pressures require CPT 93923.

Consult your healthcare provider before starting any new diagnostic or treatment program. CPT codes are registered trademarks of the American Medical Association. Coverage and reimbursement vary by geographic locality and payer. This information is provided for educational purposes and does not constitute medical or billing advice.

HealthWright Technologies is a Georgia-based healthcare technology company providing diagnostic devices built on FDA-cleared component technology to independent physician practices nationwide. To learn more about implementing ABI testing with the CMAT Advantage™, call (678) 322-7146 or email contact@healthwrighttechnologies.com. Visit us at 60 Bear Creek Marina Road, Mansfield, GA 30055.

Related HealthWright Resources

• Toe-Brachial Index: 7 Essential Facts for PAD Evaluation
• How PAD Testing Helps Independent Practices Evaluate Vascular Disease Early
• Coding the CMAT Encounter: 3 CPT Codes From One Multi-System Test
• Autonomic Function Testing CPT Code: 7 Essential Facts
• PAD Testing With the CMAT Advantage System for Independent Practices