04R

• 04R007Z Replacement of Abdominal Aorta with Autologous Tissue Substitute, Open Approach Billable
• 04R00JZ Replacement of Abdominal Aorta with Synthetic Substitute, Open Approach Billable
• 04R00KZ Replacement of Abdominal Aorta with Nonautologous Tissue Substitute, Open Approach Billable
• 04R047Z Replacement of Abdominal Aorta with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R04JZ Replacement of Abdominal Aorta with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04R04KZ Replacement of Abdominal Aorta with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R107Z Replacement of Celiac Artery with Autologous Tissue Substitute, Open Approach Billable
• 04R10JZ Replacement of Celiac Artery with Synthetic Substitute, Open Approach Billable
• 04R10KZ Replacement of Celiac Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04R147Z Replacement of Celiac Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R14JZ Replacement of Celiac Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04R14KZ Replacement of Celiac Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R207Z Replacement of Gastric Artery with Autologous Tissue Substitute, Open Approach Billable
• 04R20JZ Replacement of Gastric Artery with Synthetic Substitute, Open Approach Billable
• 04R20KZ Replacement of Gastric Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04R247Z Replacement of Gastric Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R24JZ Replacement of Gastric Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04R24KZ Replacement of Gastric Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R307Z Replacement of Hepatic Artery with Autologous Tissue Substitute, Open Approach Billable
• 04R30JZ Replacement of Hepatic Artery with Synthetic Substitute, Open Approach Billable
• 04R30KZ Replacement of Hepatic Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04R347Z Replacement of Hepatic Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R34JZ Replacement of Hepatic Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04R34KZ Replacement of Hepatic Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R407Z Replacement of Splenic Artery with Autologous Tissue Substitute, Open Approach Billable
• 04R40JZ Replacement of Splenic Artery with Synthetic Substitute, Open Approach Billable
• 04R40KZ Replacement of Splenic Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04R447Z Replacement of Splenic Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R44JZ Replacement of Splenic Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04R44KZ Replacement of Splenic Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R507Z Replacement of Superior Mesenteric Artery with Autologous Tissue Substitute, Open Approach Billable
• 04R50JZ Replacement of Superior Mesenteric Artery with Synthetic Substitute, Open Approach Billable
• 04R50KZ Replacement of Superior Mesenteric Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04R547Z Replacement of Superior Mesenteric Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R54JZ Replacement of Superior Mesenteric Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04R54KZ Replacement of Superior Mesenteric Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R607Z Replacement of Right Colic Artery with Autologous Tissue Substitute, Open Approach Billable
• 04R60JZ Replacement of Right Colic Artery with Synthetic Substitute, Open Approach Billable
• 04R60KZ Replacement of Right Colic Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04R647Z Replacement of Right Colic Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R64JZ Replacement of Right Colic Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04R64KZ Replacement of Right Colic Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R707Z Replacement of Left Colic Artery with Autologous Tissue Substitute, Open Approach Billable
• 04R70JZ Replacement of Left Colic Artery with Synthetic Substitute, Open Approach Billable
• 04R70KZ Replacement of Left Colic Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04R747Z Replacement of Left Colic Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R74JZ Replacement of Left Colic Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04R74KZ Replacement of Left Colic Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R807Z Replacement of Middle Colic Artery with Autologous Tissue Substitute, Open Approach Billable
• 04R80JZ Replacement of Middle Colic Artery with Synthetic Substitute, Open Approach Billable
• 04R80KZ Replacement of Middle Colic Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04R847Z Replacement of Middle Colic Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R84JZ Replacement of Middle Colic Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04R84KZ Replacement of Middle Colic Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R907Z Replacement of Right Renal Artery with Autologous Tissue Substitute, Open Approach Billable
• 04R90JZ Replacement of Right Renal Artery with Synthetic Substitute, Open Approach Billable
• 04R90KZ Replacement of Right Renal Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04R947Z Replacement of Right Renal Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04R94JZ Replacement of Right Renal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04R94KZ Replacement of Right Renal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RA07Z Replacement of Left Renal Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RA0JZ Replacement of Left Renal Artery with Synthetic Substitute, Open Approach Billable
• 04RA0KZ Replacement of Left Renal Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RA47Z Replacement of Left Renal Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RA4JZ Replacement of Left Renal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RA4KZ Replacement of Left Renal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RB07Z Replacement of Inferior Mesenteric Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RB0JZ Replacement of Inferior Mesenteric Artery with Synthetic Substitute, Open Approach Billable
• 04RB0KZ Replacement of Inferior Mesenteric Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RB47Z Replacement of Inferior Mesenteric Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RB4JZ Replacement of Inferior Mesenteric Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RB4KZ Replacement of Inferior Mesenteric Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RC07Z Replacement of Right Common Iliac Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RC0JZ Replacement of Right Common Iliac Artery with Synthetic Substitute, Open Approach Billable
• 04RC0KZ Replacement of Right Common Iliac Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RC47Z Replacement of Right Common Iliac Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RC4JZ Replacement of Right Common Iliac Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RC4KZ Replacement of Right Common Iliac Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RD07Z Replacement of Left Common Iliac Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RD0JZ Replacement of Left Common Iliac Artery with Synthetic Substitute, Open Approach Billable
• 04RD0KZ Replacement of Left Common Iliac Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RD47Z Replacement of Left Common Iliac Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RD4JZ Replacement of Left Common Iliac Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RD4KZ Replacement of Left Common Iliac Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RE07Z Replacement of Right Internal Iliac Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RE0JZ Replacement of Right Internal Iliac Artery with Synthetic Substitute, Open Approach Billable
• 04RE0KZ Replacement of Right Internal Iliac Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RE47Z Replacement of Right Internal Iliac Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RE4JZ Replacement of Right Internal Iliac Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RE4KZ Replacement of Right Internal Iliac Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RF07Z Replacement of Left Internal Iliac Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RF0JZ Replacement of Left Internal Iliac Artery with Synthetic Substitute, Open Approach Billable
• 04RF0KZ Replacement of Left Internal Iliac Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RF47Z Replacement of Left Internal Iliac Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RF4JZ Replacement of Left Internal Iliac Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RF4KZ Replacement of Left Internal Iliac Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RH07Z Replacement of Right External Iliac Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RH0JZ Replacement of Right External Iliac Artery with Synthetic Substitute, Open Approach Billable
• 04RH0KZ Replacement of Right External Iliac Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RH47Z Replacement of Right External Iliac Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RH4JZ Replacement of Right External Iliac Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RH4KZ Replacement of Right External Iliac Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RJ07Z Replacement of Left External Iliac Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RJ0JZ Replacement of Left External Iliac Artery with Synthetic Substitute, Open Approach Billable
• 04RJ0KZ Replacement of Left External Iliac Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RJ47Z Replacement of Left External Iliac Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RJ4JZ Replacement of Left External Iliac Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RJ4KZ Replacement of Left External Iliac Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RK07Z Replacement of Right Femoral Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RK0JZ Replacement of Right Femoral Artery with Synthetic Substitute, Open Approach Billable
• 04RK0KZ Replacement of Right Femoral Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RK47Z Replacement of Right Femoral Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RK4JZ Replacement of Right Femoral Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RK4KZ Replacement of Right Femoral Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RL07Z Replacement of Left Femoral Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RL0JZ Replacement of Left Femoral Artery with Synthetic Substitute, Open Approach Billable
• 04RL0KZ Replacement of Left Femoral Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RL47Z Replacement of Left Femoral Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RL4JZ Replacement of Left Femoral Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RL4KZ Replacement of Left Femoral Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RM07Z Replacement of Right Popliteal Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RM0JZ Replacement of Right Popliteal Artery with Synthetic Substitute, Open Approach Billable
• 04RM0KZ Replacement of Right Popliteal Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RM47Z Replacement of Right Popliteal Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RM4JZ Replacement of Right Popliteal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RM4KZ Replacement of Right Popliteal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RN07Z Replacement of Left Popliteal Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RN0JZ Replacement of Left Popliteal Artery with Synthetic Substitute, Open Approach Billable
• 04RN0KZ Replacement of Left Popliteal Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RN47Z Replacement of Left Popliteal Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RN4JZ Replacement of Left Popliteal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RN4KZ Replacement of Left Popliteal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RP07Z Replacement of Right Anterior Tibial Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RP0JZ Replacement of Right Anterior Tibial Artery with Synthetic Substitute, Open Approach Billable
• 04RP0KZ Replacement of Right Anterior Tibial Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RP47Z Replacement of Right Anterior Tibial Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RP4JZ Replacement of Right Anterior Tibial Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RP4KZ Replacement of Right Anterior Tibial Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RQ07Z Replacement of Left Anterior Tibial Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RQ0JZ Replacement of Left Anterior Tibial Artery with Synthetic Substitute, Open Approach Billable
• 04RQ0KZ Replacement of Left Anterior Tibial Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RQ47Z Replacement of Left Anterior Tibial Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RQ4JZ Replacement of Left Anterior Tibial Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RQ4KZ Replacement of Left Anterior Tibial Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RR07Z Replacement of Right Posterior Tibial Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RR0JZ Replacement of Right Posterior Tibial Artery with Synthetic Substitute, Open Approach Billable
• 04RR0KZ Replacement of Right Posterior Tibial Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RR47Z Replacement of Right Posterior Tibial Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RR4JZ Replacement of Right Posterior Tibial Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RR4KZ Replacement of Right Posterior Tibial Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RS07Z Replacement of Left Posterior Tibial Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RS0JZ Replacement of Left Posterior Tibial Artery with Synthetic Substitute, Open Approach Billable
• 04RS0KZ Replacement of Left Posterior Tibial Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RS47Z Replacement of Left Posterior Tibial Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RS4JZ Replacement of Left Posterior Tibial Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RS4KZ Replacement of Left Posterior Tibial Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RT07Z Replacement of Right Peroneal Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RT0JZ Replacement of Right Peroneal Artery with Synthetic Substitute, Open Approach Billable
• 04RT0KZ Replacement of Right Peroneal Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RT47Z Replacement of Right Peroneal Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RT4JZ Replacement of Right Peroneal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RT4KZ Replacement of Right Peroneal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RU07Z Replacement of Left Peroneal Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RU0JZ Replacement of Left Peroneal Artery with Synthetic Substitute, Open Approach Billable
• 04RU0KZ Replacement of Left Peroneal Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RU47Z Replacement of Left Peroneal Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RU4JZ Replacement of Left Peroneal Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RU4KZ Replacement of Left Peroneal Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RV07Z Replacement of Right Foot Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RV0JZ Replacement of Right Foot Artery with Synthetic Substitute, Open Approach Billable
• 04RV0KZ Replacement of Right Foot Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RV47Z Replacement of Right Foot Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RV4JZ Replacement of Right Foot Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RV4KZ Replacement of Right Foot Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RW07Z Replacement of Left Foot Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RW0JZ Replacement of Left Foot Artery with Synthetic Substitute, Open Approach Billable
• 04RW0KZ Replacement of Left Foot Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RW47Z Replacement of Left Foot Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RW4JZ Replacement of Left Foot Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RW4KZ Replacement of Left Foot Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RY07Z Replacement of Lower Artery with Autologous Tissue Substitute, Open Approach Billable
• 04RY0JZ Replacement of Lower Artery with Synthetic Substitute, Open Approach Billable
• 04RY0KZ Replacement of Lower Artery with Nonautologous Tissue Substitute, Open Approach Billable
• 04RY47Z Replacement of Lower Artery with Autologous Tissue Substitute, Percutaneous Endoscopic Approach Billable
• 04RY4JZ Replacement of Lower Artery with Synthetic Substitute, Percutaneous Endoscopic Approach Billable
• 04RY4KZ Replacement of Lower Artery with Nonautologous Tissue Substitute, Percutaneous Endoscopic Approach Billable

Version History

How 04R appears in each release imported from the official files, newest first.

1. FY 2027 Effective October 1, 2026

   Current

   Lower Arteries, Replacement

2. FY 2026 Effective October 1, 2025

   Unchanged

   Lower Arteries, Replacement