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    OpenPayerBilling CodesDirect Repair of Aneurysm or Excision (Partial or Total) and Graft Insertion for Aneurysm, Pseudoaneurysm, Ruptured Aneurysm, and Associated Occlusive Disease ProceduresCPT cpt-35021-subclavian-innominate-artery-repair-graft
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    CPT 35021: Repair of Subclavian or Innominate Artery Aneurysm

    Medicare pays $1219 on average nationally for this procedure.

    CPT code 35021 describes open surgical access to a subclavian or innominate artery aneurysm or pseudoaneurysm via a chest incision with direct arterial repair or placement of a graft; this is a vascular surgery procedure typically performed in an operating room or inpatient surgical suite and classified as an open arterial repair service for major thoracic/upper‑extremity vessels.

    For related coverage guidance, see recent payer policy updates: Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure, Cardiology - Ivabradine, Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA).

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 62-year-old male presenting with chest pain, localized shoulder swelling, or signs of distal upper-extremity ischemia. Imaging (CT angiography or duplex ultrasound) identifies an aneurysm or pseudoaneurysm of the subclavian or innominate (brachiocephalic) artery with risk for rupture, embolization, or limb-threatening ischemia. The vascular surgery team evaluates comorbidities (cardiac, pulmonary), reviews vascular imaging, and obtains informed consent. In the operating room or hybrid suite under general anesthesia, the surgeon performs a median sternotomy, supraclavicular, or thoracotomy incision to expose the affected subclavian or innominate artery. The procedure includes proximal and distal control, aneurysm sac management, and either direct arterial repair (primary suture repair) or interposition graft placement (vein or prosthetic graft) as indicated by vessel damage and tissue quality. Intraoperative monitoring may include arterial lines, transesophageal echocardiography, and neurophysiologic monitoring when indicated. Postoperative care includes intensive monitoring for bleeding, graft patency assessment with duplex or CT angiography, pain control, anticoagulation management as indicated, and discharge planning with follow-up imaging and vascular clinic visits. Typical sites of service are the operating room in a hospital inpatient or outpatient surgical center and, when complex exposure is required or the patient has hemodynamic instability, inpatient hospitalization with ICU-level monitoring.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    35021Repair of aneurysm or pseudoaneurysm, subclavian or innominate artery; open, with direct repair or interposition graftThis is the principal procedure described; used for open surgical repair of subclavian or innominate artery aneurysms or pseudoaneurysms
    34841Resection of innominate artery aneurysm with interposition graft (example related thoracic arterial repair)May represent an alternative or related thoracic arterial repair code when procedure extent involves adjacent great vessels (use depending on operative detail)
    35701Repair, carotid artery, with interposition graft or patch (related cervical arterial repair)Performed when concomitant carotid exposure or repair is required during exposure or when proximal extension involves carotid circulation
    37184Endovascular repair of arterial aneurysm or pseudoaneurysm, percutaneous, including endograft deploymentUsed in hybrid cases where endovascular stent grafting is performed in addition to or instead of open repair
    33999Unlisted procedure, cardiac or vascular surgeryUsed when a specific procedure is not represented by existing codes and detailed operative report justifies unlisted billing

    Related Modifiers

    14 rows

    ModifierDescriptionWhen to Use
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…

    Showing 1–10 of 14

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RG0100X
    208800000X
    207L00000X
    207T00000X
    363A00000X
    176P00000X
    2084B0040X
    163WN0800X

    Related ICD-10-CM Codes

    21 rows

    ICD-10-CM CodeDescription
    I65.21Occlusion and stenosis of right carotid artery
    I65.22Occlusion and stenosis of left carotid artery
    I65.29Occlusion and stenosis of unspecified carotid artery
    I66.9Occlusion and stenosis of unspecified cerebral artery
    I71.9Aortic aneurysm of unspecified site, without rupture
    I72.4Aneurysm of artery of lower extremity
    I72.8Aneurysm of other specified arteries
    I72.9Aneurysm of unspecified site
    I74.3Embolism and thrombosis of arteries of the lower extremities
    I74.5Embolism and thrombosis of iliac artery

    Showing 1–10 of 21

    Related Payer Policy Updates

    Specialty: Cardiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood PressureBluecross Idaho2026-11-01
    Cardiology - IvabradineCigna2026-10-15
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Percutaneous Ventricular Assist DeviceUnitedHealthcare2026-10-01
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Left Atrial Appendage Closure Devicesexcellus_health_plan_inc2026-09-17
    Left Atrial Appendage Closure Devicesuniverahealthcare2026-09-17
    Cardiac Omnibus CodesCigna2026-09-15

    Related Codes

    CPT-35001-CAROTID-SUBCLAVIAN-ARTERIAL-REPAIR-GRAFT-PLACEMENT

    CPT 35001: Carotid or Subclavian Artery Repair with Graft

    CPT-35002-CAROTID-SUBCLAVIAN-ARTERY-OPEN-REPAIR-ANEURYSM

    CPT 35002: Open Repair/Graft of Carotid or Subclavian Artery

    CPT-35005-VERTEBRAL-ARTERY-REPAIR-OR-GRAFT-PLACEMENT

    CPT 35005: Open Repair of Vertebral Artery Aneurysm or Pseudoaneurysm

    CPT-35011-AXILLARY-BRACHIAL-ARTERY-ANEURYSM-REPAIR

    CPT 35011: Axillary–Brachial Artery Repair or Graft Placement

    CPT-35013-AXILLARY-BRACHIAL-ARTERY-REPAIR-GRAFT

    CPT 35013: Axillary–Brachial Artery Repair or Graft

    CPT-35022-SUBCLAVIAN-INNOMINATE-ARTERY-OPEN-REPAIR-GRAFT

    CPT 35022: Open Repair of Ruptured Subclavian or Innominate Artery

    CPT-35045-RADIAL-ULNAR-ARTERY-REPAIR-FOREARM

    CPT 35045: Repair of Radial or Ulnar Artery Aneurysm or Pseudoaneurysm

    CPT-35081-OPEN-ABDOMINAL-AORTIC-ANEURYSM-REPAIR

    CPT 35081: Open Repair of Abdominal Aortic Aneurysm

    CPT-35082-OPEN-REPAIR-RUPTURED-ABDOMINAL-AORTIC-ANEURYSM

    CPT 35082: Open Repair of Ruptured Abdominal Aortic Aneurysm

    CPT-35091-OPEN-ABDOMINAL-AORTIC-ANEURYSM-REPAIR-OR-GRAFT

    CPT 35091: Open Abdominal Aortic Aneurysm Repair

    Showing 1–10 of 23

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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