Summary & Overview

CPT 35013: Axillary–Brachial Artery Repair, Direct Repair or Graft

CPT code 35013 denotes open vascular surgical repair of a ruptured axillary–brachial artery aneurysm with treatment of concurrent occlusive disease, using direct arterial repair or graft placement. This procedure is clinically significant nationwide because ruptured upper-extremity arterial aneurysms are urgent vascular events that require prompt surgical intervention to prevent hemorrhage, limb ischemia, or long-term functional loss. Billing and coding clarity for this service affects hospital surgical revenue, payer authorization, and case-level classification for quality measurement.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent and typical sites of service, plus benchmarks and policy-relevant considerations where available. The publication highlights coding context, common modifier usage (listed separately), and areas where payer policies often vary, such as inpatient versus outpatient setting determinations and graft material coverage. The content supports clinicians, coders, and policy analysts by summarizing the procedure's clinical scope, listing primary payers, and identifying where additional documentation or payer-specific policy review may be required. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35013CPTvascular-surgeryaxillary-brachial-arteryaneurysm-repairgraft-placementoperative-proceduresurgical-coding

Billing Code Overview

CPT code 35013 describes a surgical procedure involving an incision in the arm to access the axillary–brachial artery for treatment of a ruptured aneurysm and associated occlusive disease. The procedure includes advancing into the target arterial segment, performing direct repair or placing a graft over the repair site.

Service type: Open vascular surgical repair of axillary–brachial artery aneurysm and occlusive disease
Typical site of service: Operative setting such as an inpatient hospital operating room or outpatient surgical center, depending on clinical status and institutional practice

Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting with acute arm and/or shoulder pain, a pulsatile mass in the axillary region, distal ischemia (cool, pale hand), or expanding hematoma after trauma or with sudden worsening of chronic aneurysmal disease. Preoperative evaluation includes vascular exam, duplex ultrasound and computed tomography angiography to confirm a ruptured axillary–brachial artery aneurysm and to delineate occlusive disease and distal runoff. The procedure is usually performed in an operating room or hybrid vascular suite under general or regional anesthesia. The vascular surgeon obtains proximal and distal control through an incision in the arm, evacuates hematoma if present, and then performs direct arterial repair (primary repair or patch angioplasty) or places an interposition graft (autologous vein or prosthetic) to exclude the ruptured segment and restore arterial continuity. Intraoperative completion angiography or Doppler assessment confirms flow. Postoperative care includes monitoring for bleeding, limb perfusion checks, anticoagulation or antiplatelet management per protocol, and follow-up duplex surveillance. Typical sites of service are the hospital operating room or a hospital-based ambulatory surgery/hybrid vascular suite. Common clinical team members include the vascular surgeon, anesthesiologist, surgical technologist, and vascular nursing staff. Disposition is commonly same-day observation or inpatient admission depending on hemodynamic status and complications.

Coding Specifications

Modifier	Description	When to Use
`11`	Normally scheduled service	When the procedure is performed as planned without complications.
`22`	Increased procedural services	When work, time, or complexity is significantly greater than typical for `35013` (document rationale).
`52`	Reduced services	When the procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	When the procedure is terminated due to extenuating circumstances (document reason).
`62`	Two surgeons	When two surgeons with different specialties work together as primary surgeons.
`66`	Surgical team (multiple surgeons)	When a surgical team approach is used for a complex vascular repair.
`78`	Return to OR for related procedure during global period	For a return to the OR for a related vascular complication within the global period.
`80`	Assistant surgeon	When a surgical assistant (physician) assists during the operation.
`81`	Minimum assistant surgeon	When a minimal assistant role is documented.
`26`	Professional component	When billing only the professional component separate from facility technical component (rare for `35013`).
`50`	Bilateral procedure	If bilateral upper-extremity arterial repairs are performed (apply when both sides are treated).
`52`	Reduced services	When a limited repair is performed vs full planned reconstruction.
`54`	Surgical care only	When billing surgical services separate from pre/post op global care.
`55`	Postoperative management only	When only postoperative care is provided by the reporting surgeon.

Taxonomy Code	Specialty	Notes
2080P00000X	Vascular Surgery	Primary specialty performing axillary–brachial arterial repairs and grafting.
2080S0122X	Thoracic and Cardiac Surgery	May participate for complex proximal upper-extremity vascular injuries.
207RH0000X	General Surgery	General surgeons with vascular expertise may perform this repair.
2086P0200X	Interventional Cardiology	May be involved for endovascular adjuncts in hybrid cases.
2084P0800X	Plastic and Reconstructive Surgery	Occasionally involved for soft tissue or reconstructive needs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I72.7`	Aneurysm of other specified arteries	Directly relevant when an axillary–brachial artery aneurysm is the indication for repair.
`S45.02XA`	Injury of brachial artery, initial encounter	Traumatic arterial injury causing rupture or bleeding requiring arterial repair.
`I74.3`	Embolism and thrombosis of arteries of upper extremities	Presents with acute ischemia and may necessitate thrombectomy and arterial repair.
`I65.23`	Occlusion and stenosis of bilateral carotid arteries (example placeholder)`	Data not available in the input.
`T79.A11A`	Traumatic amputation of right upper limb, initial encounter	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35011`	Thromboembolectomy, brachial artery, with or without catheter-directed thrombolysis	Performed when embolic occlusion coexists and thromboembolectomy is needed before or during repair.
`35571`	Thromboendarterectomy, axillary or brachial artery	Alternative or adjunct when plaque or occlusive disease within the artery requires endarterectomy.
`37220`	Revascularization, endovascular; open femoral or popliteal, including iliac when performed	Represents endovascular revascularization codes used in hybrid cases (note: select appropriate upper-extremity endovascular codes as clinically applicable).
`36471`	Endovascular revascularization, therapeutic, with stent, distal upper extremity (examples)	Used when endovascular stent placement in the axillary–brachial segment is performed as part of repair.
`76000`	Fluoroscopy; first image	Imaging support codes used intraoperatively for arteriography or completion angiography.
`76937`	Ultrasound guidance for vascular access	Used when ultrasound is used for arterial access or localization during the procedure.
`37186`	Transcatheter placement of intravascular stent(s), open lower/upper extremity (as applicable)	Used when stent deployment is part of the repair strategy in hybrid procedures.