Thoracic Branch Endograft (TBE): 2026 Guidelines and Updates
The 2026 CPT® code updates bring significant changes to thoracic branch endograft (TBE) procedures, as well as broader updates across imaging, radiology, and endovascular services. These revisions aim to improve reporting accuracy, align codes with modern technology, and reduce inconsistencies in documentation.
What Is a Thoracic Branch Endograft?
A thoracic branch endograft (TBE) is an endovascular device placed in the thoracic aorta to treat complex aneurysms and dissections while preserving blood flow to critical branch vessels. These procedures are typically performed in hybrid operating rooms or interventional radiology suites using advanced imaging guidance.
Key 2026 CPT® Updates Affecting TBE Procedures
For 2026, thoracic branch endograft services now have dedicated structured reporting options, replacing older and less precise reporting pathways. These changes are part of a broader modernization of endovascular coding.
Major related updates include:
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New Category I CPT® codes replacing older Category III codes for:
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Head and neck CTA (computed tomography angiography)
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CT perfusion (CTP)
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New codes for irreversible electroporation (IRE) of the liver and prostate
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Revised prostate biopsy codes
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Updates to sacroiliac arthrodesis reporting
These changes reflect the growing complexity of minimally invasive vascular and radiologic procedures.
Imaging Guidance Changes That Impact TBE Coding
Imaging guidance rules are one of the most important changes for 2026. Coders should anticipate increased bundling of imaging services and reduced opportunities for separate reporting.
Imaging modalities commonly associated with TBE procedures include:
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Fluoroscopy
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CT (computed tomography)
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Ultrasound
Under the 2026 updates, some imaging services may now be bundled into the primary endovascular code, depending on the clinical scenario. This directly impacts previously unbundled services, including codes such as 61624 and 61626, which are now subject to revised bundling rules.
Bundling and Endovascular Guideline Revisions
The 2026 guidelines also revise definitions and reporting expectations for:
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Vascular embolization/occlusion procedures
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Endovascular therapy services
These revisions affect how coders determine whether services are separately reportable or inherently included in the primary procedure. For TBE cases, this is critical because multiple devices, branch components, and imaging techniques are often used during the same session.
Medical Coding Bundling and Upcoding
Documentation Requirements for 2026 Compliance
To support accurate billing under the new rules, provider documentation must be more detailed than ever. Records should clearly describe:
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The exact procedure performed
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The vascular territory treated (e.g., thoracic aorta and branch vessels)
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The approach used (endovascular vs. open)
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The type of device(s) placed
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The imaging modality used and how it was applied
Incomplete documentation will increase the risk of denials and audits under the 2026 code structure.
Coding Tips for Thoracic Branch Endograft Procedures
To stay compliant with 2026 CPT® rules, coders should:
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Verify which imaging modality was used and whether it remains separately reportable
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Confirm whether embolization or occlusion services are bundled
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Map deleted codes to the new structured thoracic branch endograft code set effective January 1, 2026
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Review operative reports for device type, vascular territory, and imaging details before code selection
Key 2026 Takeaway for Coders
The shift to structured thoracic branch endograft reporting represents a major change in endovascular coding. Coders must:
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Remove outdated codes from their systems
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Apply new Category I codes correctly
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Ensure documentation supports the new detail requirements
Proper preparation now will help practices avoid denials, underpayments, and compliance risks when the 2026 changes go live.
CMS Billing and Coding: Endovascular Repair of Aortic and/or Iliac Aneurysms