CPT 35206 Upper Extremity Vascular Repair Reimbursement | OpenPayer

Summary & Overview

CPT 35206: Upper Extremity Vascular Repair

CPT code 35206 denotes a surgical vascular repair of an upper extremity vessel involving incision, hemorrhage control, and vessel closure. This procedure is used in trauma and nontraumatic vascular injuries where direct surgical control and repair of an arm or forearm vessel is required. Nationally, accurate coding for this procedure affects surgical case mix reporting, hospital reimbursement, and quality measurement for vascular and trauma services.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the code, common sites of service, and the typical surgical service line. The publication also outlines payer coverage considerations and common billing modifiers associated with vascular surgical procedures. Where available, benchmarks and utilization patterns for surgical vascular repair are summarized, along with recent policy updates that affect coding and reimbursement for operative vascular services.

This material is intended for professional audiences seeking a clear understanding of what CPT code 35206 represents, how it is used in clinical and billing workflows, and which payers commonly cover the service. Data not available in the input has been noted and omitted from sections that require external details.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35206CPTvascular repairupper extremitysurgeryoperating roomtraumabillingreimbursement

Billing Code Overview

CPT code 35206 describes a surgical procedure in which the provider makes an incision over an affected vessel in the upper extremity, controls bleeding in the vessel, and closes the vessel. This procedure is a vascular repair of an upper extremity vessel.

Service type: Surgical vascular repair
Typical site of service: Operating room or surgical suite, ambulatory surgical center, or other inpatient surgical setting depending on clinical context and patient condition

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting with traumatic injury or iatrogenic damage to an upper extremity artery or vein (for example, radial artery laceration from a distal forearm trauma or a complication following arterial catheterization). The patient arrives through the emergency department or is referred from the operating room after intraoperative recognition of vessel injury. Initial workflow includes triage, focused vascular and neurovascular exam, hemodynamic stabilization, and imaging as indicated (e.g., duplex ultrasound or CT angiography). The vascular surgeon or trauma surgeon performs this procedure at the bedside in an operating room or surgical suite under regional or general anesthesia. The surgeon makes a targeted incision over the affected vessel in the upper extremity, controls bleeding with proximal and distal vascular control, and definitively closes the vessel (repair, ligation, or primary closure) to restore hemostasis and preserve distal perfusion. Postoperative care includes monitoring distal pulses, wound care, pain control, and vascular follow-up with possible antithrombotic management if a repair was performed.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work required to control bleeding and close the vessel is substantially greater than typical (document reason and extent).

CPT 35216: Open Thoracic Vessel Repair Without Cardiopulmonary Bypass

CPT-35266-UPPER-EXTREMITY-ARTERIAL-REPAIR-NON-VENOUS-GRAFT

CPT 35266: Upper-Extremity Arterial Repair with Non–Venous Graft

CPT-35221-ABDOMINAL-VESSEL-REPAIR

CPT 35221: Abdominal Blood Vessel Repair

CPT-35251-INTRA-ABDOMINAL-VESSEL-REPAIR-VEIN-GRAFT

CPT 35251: Intra-abdominal Vessel Repair with Vein Graft

CPT-35226-LOWER-EXTREMITY-VASCULAR-REPAIR

CPT 35226: Repair of Lower Extremity Blood Vessel

CPT-35231-NECK-VESSEL-REPAIR-WITH-VEIN-GRAFT

CPT 35231: Repair of Neck Blood Vessel with Vein Graft

CPT-35261-NECK-BLOOD-VESSEL-REPAIR-NON-VENOUS-GRAFT

CPT 35261: Neck Blood Vessel Repair With Non–Venous Graft

CPT-35241-INTRATHORACIC-VESSEL-REPAIR-VEIN-GRAFT-CPB

CPT 35241: Intrathoracic Vessel Repair with Vein Graft, on Cardiopulmonary Bypass

CPT-35246-INTRATHORACIC-VASCULAR-REPAIR-VEIN-GRAFT-NO-BYPASS

CPT 35246: Intrathoracic Blood Vessel Repair with Vein Graft, No Bypass

CPT-35271-INTRATHORACIC-VESSEL-REPAIR-NONVENOUS-GRAFT-BYPASS

CPT 35271: Intrathoracic Vessel Repair with Non‑venous Graft and Bypass

Showing 1–10 of 18

23

Taxonomy Code	Specialty	Notes
207K00000X	Vascular Surgery	Primary specialty for upper extremity arterial/venous repair and vessel control.
2080P0205X	General Surgery	Commonly performs emergent vascular control in trauma or intraoperative settings.
208000000X	Thoracic and Cardiac Surgery	May perform complex proximal upper extremity arterial repairs in select cases.
207L00000X	Plastic Surgery	Performs peripheral vessel repair in reconstructive or traumatic settings.
208VP0000X	Trauma Surgery	Common provider for acute traumatic vascular injuries in the extremity.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S48.091A`	Unspecified injury of right axillary artery, initial encounter	Traumatic arterial injury of upper extremity requiring vessel control and repair.
`S48.092A`	Unspecified injury of left axillary artery, initial encounter	Left-sided traumatic arterial injury requiring surgical hemostasis and closure.
`I74.3`	Embolism and thrombosis of arteries of upper extremities	Acute arterial occlusion may require surgical exploration and vessel control or embolectomy with vessel repair.
`T81.0XXA`	Hemorrhage and hematoma complicating a procedure, initial encounter	Postprocedural bleeding in the upper extremity that necessitates re-exploration and vessel closure.
`S65.811A`	Laceration without foreign body of right radial artery, initial encounter	Distal arterial laceration commonly managed with incision, bleeding control, and vessel repair.
`S65.812A`	Laceration without foreign body of left radial artery, initial encounter	Left radial artery laceration requiring surgical hemostasis and closure.
`I77.6`	Arterial aneurysm, nontraumatic, of upper extremity	Ruptured or leaking aneurysm may require incision, bleeding control, and vessel closure or repair.
`S45.01XA`	Puncture wound without foreign body of right axillary artery, initial encounter	Iatrogenic or penetrating puncture injuries leading to arterial bleeding managed by this procedure.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35206`	Repair of vessel with control of bleeding; vessel of upper extremity — incision, control of bleeding and closure of vessel	Primary procedure: incision over affected upper extremity vessel, control hemorrhage, and close vessel.
`35701`	Repair, blood vessel, arm or leg, direct; one vessel	May be used for more extensive limb vessel repairs involving reconstruction rather than simple control and closure.
`35221`	Repair of blood vessel; vein, arm or leg, with graft (includes control of bleeding)	Used when vein repair requires patch or interposition graft rather than simple closure.
`36415`	Collection of venous blood by venipuncture	Often performed preoperatively for labs, crossmatch, or coagulation studies prior to vascular repair.
`93925`	Duplex scan of extremity veins, unilateral or segmental study	Preoperative or postoperative vascular imaging to assess flow or rule out thrombosis.
`99100`	Anesthesia for patient of extreme age, younger than 1 year or older than 70 years, requiring special critical care	Used when anesthesia considerations increase complexity for elderly patients (example of applicable anesthesia-related code).

OpenPayer