What is Peripheral Artery Disease (PAD)?

PAD is a circulatory condition in which narrowed arteries reduce blood flow to the limbs, most commonly the legs. It is associated with significantly elevated risk of heart attack, stroke, and lower limb amputation. Routine ABI screening enables early detection before symptoms become limb-threatening.

What is an Ankle-Brachial Index (ABI) test?

A non-invasive test comparing blood pressure at the ankle to the arm. An ABI below 0.90 is diagnostic for PAD. ABI testing is the first-line screening tool recommended by the AHA and Society for Vascular Surgery and is reimbursable under Medicare CPT codes 93922, 93923, and 93924.

What ABI value indicates PAD?

An ABI below 0.90 is diagnostic for PAD. Values of 0.91–1.30 are normal. An ABI above 1.40 suggests arterial calcification and may require Toe-Brachial Index (TBI) testing for accurate vascular assessment.

Is ABI testing reimbursable? What CPT codes apply?

Yes. Single-level bilateral ABI is billed under CPT 93922. CPT 93923 covers two scenarios: multi-level segmental studies (3-cuff, 4-cuff) and single-level studies with provocative functional maneuvers such as dorsiflexions, heel raises, or hall walking. Treadmill stress ABI is billed under CPT 93924. Confirm specific code selection with your billing team based on your testing protocols and payer contracts.

When is Toe-Brachial Index (TBI) testing indicated?

TBI is used when ankle ABI is non-diagnostic — particularly in patients with diabetes, CKD, or advanced age, whose ankle arteries may be calcified. Toe arteries are rarely affected by calcification. A TBI below 0.70 is generally diagnostic for PAD.

What is Pulse Volume Recording (PVR)?

PVR measures volume changes in arterial blood flow through pneumatic cuffs, producing diagnostic waveforms without a Doppler probe. PVR waveforms grade arterial flow character — normal, mildly, moderately, or severely abnormal — and are used in both the ABI-Q and segmental exam protocols.

What is a segmental pressure study?

Measures blood pressure at multiple leg levels simultaneously. A gradient greater than 20 mmHg between adjacent segments indicates occlusion at that level, allowing localization to the aortoiliac, femoral-popliteal, or tibial segment — critical for intervention planning.

What is an Exercise ABI test, and how does it differ from treadmill stress testing?

Exercise ABI measures ABI before and after provocative functional maneuvers — dorsiflexions, heel raises, or hall walking — without a treadmill. Over 30% of patients with a normal resting ABI will show signs of PAD with exercise. A post-exercise drop of 20% or more confirms PAD. This exam is billed under CPT 93923 (single-level study with provocative functional maneuvers). The ABI Stress-Treadmill exam uses a formal treadmill walking protocol and is billed separately under CPT 93924.