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Taste of Boston
Taste of Boston

P8: Plenary Session 8

SS18 - VA Community Care Vascular Surgery Costs are dominated by endovascular interventions for peripheral arterial disease

Saturday, June 13, 2026
11:35 AM - 11:46 AM ET
Location: Hynes CC, Third Level, Ballroom A

    Presenting Author only(s)

  • Daniel J. Koh, MD

    Integrated Vascular Surgery Resident
    Division of Vascular Surgery, University of Washington School of Medicine
    Seattle, Washington

    • Senior Author Discussant(s)

  • Gale L. Tang, MD (she/her/hers)

    Associate Professor of Vascular Surgery
    University of Washington
    Seattle, Washington

    • Co-Author(s)

  • MC

    Michael J. Costanza

    Professor
    Upstate Medical University
    Syracuse, New York

Objectives: The 2019 MISSION ACT for expanding access for Veterans to receive care outside of the VA healthcare system (Community Care) has resulted in a significant increase in vascular surgery Community Care referrals and cost, especially endovascular, over time. We hypothesized that these trends would continue over time after adding fiscal years 2023-2025 to the analysis.

Methods: The VA Community Care Referral (CCR) Dashboard and Integrated Informatics and Analytics from fiscal years 2020 to 2025 were used to obtain number of referrals, justification for Community Care, cost, and total paid claims for Vascular Surgery-related Current Procedural Terminology (CPT) codes from all VA centers nationwide. Iliac codes were defined as 37220, 37221, 37223. Infrainguinal endovascular codes were defined as 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 372233.

Results: Vascular Surgery CCRs nearly tripled from 21,407 in 2020 to 62,487 in 2025. The most common cause for referral was distance from a VA facility and accounted for 88% of referrals. The top charged CPT code across all 6 years analyzed was 37225 (Femoral-popliteal atherectomy), except for 2022 when it was second to 37227 (Femoral-popliteal atherectomy with stenting), with an increase over time of $4.5 million paid for this claim in 2020 to $9.9 million in 2025. The highest non-endovascular arterial intervention paid code was 36475 (RFA 1st incompetent vein), which ranged between the 7th-9th highest paid code. Overall iliac endovascular paid claims increased from $1.65 million in 2020 to $5.6 million in 2025 (3.4 fold increase) whereas included infrainguinal endovascular paid claims increased from $8.8 million to $40.2 million (4.6 fold increase). The percentage of infrainguinal endovascular charges due to atherectomy codes from 2020-2025 has been relatively consistent ranging between 60.1%-67% of charges. No open bypass or groin level reconstruction codes appeared within the top 30 paid codes for the entirety of the study period.

Conclusions: Infrainguinal endovascular interventions for peripheral arterial disease represent the largest share of VA Community Care vascular surgical paid charges and have continued to increase over time. The proportion of charges related to atherectomy procedures has not significantly changed over the last 6 years.