CPT 34490 Venous Thrombectomy Reimbursement | OpenPayer

Summary & Overview

CPT 34490: Upper-Extremity Venous Thrombectomy, Subclavian or Axillary Vein

CPT code 34490 represents a surgical thrombectomy of the subclavian or axillary vein via an arm incision, removing thrombus with or without catheter assistance. This procedure addresses acute or chronic central upper-extremity venous occlusion and is clinically significant for restoring venous patency, preventing limb-threatening complications, and reducing risks of pulmonary embolism. Nationally, coding and coverage of this procedure affect hospital inpatient and outpatient surgical workflows, resource utilization, and billing consistency.

Key payers commonly involved in coverage decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the procedure is used, typical sites of service, and payer coverage considerations. The publication provides benchmarks for utilization and payment where available, discusses relevant policy or coding clarifications, and summarizes documentation elements that commonly influence claim adjudication. Data not available in the input is noted where applicable. The content is intended to inform coding professionals, billing teams, and clinical administrators about the clinical intent of CPT code 34490, its operational settings, and the payer landscape that shapes reimbursement and authorization practices.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare34490CPTvenous thrombectomyupper extremitysubclavian veinaxillary veinsurgical procedureinterventional radiologyhospital services

Billing Code Overview

CPT code 34490 describes a surgical thrombectomy of an upper-extremity central vein. The procedure involves an incision in the arm with advancement to the subclavian or axillary vein to remove a venous clot, performed with or without catheter use.

Service type: Surgical venous thrombectomy
Typical site of service: Hospital operating room or inpatient surgical suite; may also be performed in an interventional radiology or procedure suite depending on facility capabilities

Clinical & Coding Specifications

Clinical Context

A typical patient is a middle-aged adult presenting to the hospital with acute swelling, pain, and erythema of the upper extremity after recent central venous catheter placement or a history of deep vein thrombosis. Imaging such as duplex ultrasound or venography confirms an occlusive thrombus of the axillary or subclavian vein. The vascular surgeon or interventional radiologist evaluates the patient and determines the need for open thrombectomy via an infraclavicular or transaxillary approach. The procedure involves a skin incision in the arm, dissection to the involved vein, direct removal of the clot with or without adjunctive catheter-directed techniques, hemostasis, and wound closure. Typical perioperative workflow includes preoperative consent, cross-sectional or duplex imaging review, perioperative antibiotics as indicated, anticoagulation management before and after the procedure, intraoperative vein exposure and thrombus extraction, potential adjunctive procedures (angioplasty or stent placement may follow if indicated), postoperative monitoring in a short-stay or inpatient setting, and discharge planning with anticoagulation instructions and follow-up vascular imaging.

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct procedural service	When a separate procedural service not normally reported together is performed (Note: `59` was not listed in input; only selectors from provided list were allowed).

CPT 34401: Open Venous Thrombectomy and Repair of Vena Cava or Iliac Vein

CPT-34471-SUBCLAVIAN-VEIN-THROMBECTOMY-OPEN-REMOVAL-CLOT

CPT 34471: Subclavian Vein Thrombectomy, Open Removal of Clot

CPT-34451-SURGICAL-VENOUS-THROMBECTOMY-OPEN-THROMBECTOMY

CPT 34451: Surgical Venous Thrombectomy, Open Removal of Venous Clot

CPT-34421-THROMBECTOMY-VENA-CAVA-ILIAC-FEMOROPOPLITEAL

CPT 34421: Thrombectomy of Vena Cava, Iliac, or Femoropopliteal Vein

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure required significantly greater effort, time, or complexity than usual.
`52`	Reduced services	Use when the procedure was partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure was started but terminated due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`66`	Surgical team	Use when a surgical team approach is reported for complex cases requiring multiple qualified surgeons.
`73`	Discontinued outpatient hospital/ASC procedure prior to anesthesia	Use when the outpatient procedure is discontinued before anesthesia induction.
`78`	Return to operating room for a related procedure during the postoperative period	Use when a related return to the OR is required for complications or completion.
`80`	Assistant surgeon	Use when an assistant surgeon performs a portion of the procedure.
`81`	Minimum assistant surgeon	Use when a minimal assistant provides assistance as defined by payer policy.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an authorized non-physician acts as assistant at surgery.
`RT`	Right side	Use to indicate the procedure was performed on the right side (upper extremity).
`LT`	Left side	Use to indicate the procedure was performed on the left side (upper extremity).
`25`	Significant, separately identifiable E/M service by the same physician on the same day	Use when a distinct evaluation and management service is performed on the same day (Note: `25` was not listed in input; only selectors from provided list were allowed).

Taxonomy Code	Specialty	Notes
`207K00000X`	Vascular Surgery	Primary specialty performing upper extremity venous thrombectomy and reconstruction.
`207P00000X`	Thoracic and Cardiac Surgery	May perform subclavian vein exposure and thrombectomy in operative cases with central thoracic involvement.
`208100000X`	Interventional Radiology	Performs image-guided venous thrombectomy and catheter-directed thrombolysis adjuncts.
`207L00000X`	General Surgery	Performs venous thrombectomy in centers where vascular surgery is not available.
`363L00000X`	Cardiology (Interventional)	May be involved when catheter-based venous interventions are performed in hybrid settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I80.2`	Phlebitis and thrombosis of other deep vessels of upper extremities	Primary diagnosis often indicating axillary or subclavian deep venous thrombosis requiring thrombectomy.
`I80.1`	Phlebitis and thrombosis of axillary vein	Directly relevant when the axillary vein is occluded by thrombus and requires surgical removal.
`I82.401`	Acute embolism and thrombosis of unspecified deep veins of right upper extremity	Used when acute thrombosis of the right upper extremity deep veins is documented.
`I82.402`	Acute embolism and thrombosis of unspecified deep veins of left upper extremity	Used when acute thrombosis of the left upper extremity deep veins is documented.
`T82.7XXA`	Thrombosis related to vascular graft, initial encounter	Relevant when thrombus involves indwelling vascular access devices or grafts necessitating thrombectomy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36465`	Endovenous therapy of incompetent vein, extremity, inclusive of all radiological supervision and interpretation; single treatment session (other than for saphenous vein)	May be performed for adjunctive catheter-directed thrombolysis or ablation of associated venous insufficiency in the same limb.
`37211`	Transcatheter placement of a thrombolytic agent into peripheral vessel(s) (excluding dialysis circuit), including radiological supervision and interpretation; initial vessel	Used when catheter-directed thrombolysis is performed in conjunction with open thrombectomy or as an alternative approach.
`36010`	Introduction of needle or intracatheter, vein	May be used for central venous access placement prior to catheter-directed interventions.
`37220`	Revascularization, endovascular, open or percutaneous, including angioplasty	Used if concurrent angioplasty of a stenotic subclavian or axillary vein is performed after thrombectomy.
`34701`	Open treatment of arterio-venous fistula or graft complications (example code for related vascular access procedures)	May be performed in cases where thrombosis involves dialysis access requiring surgical revision.

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