CPT 35226 Lower Extremity Repair Reimbursement

CPT code 35226 denotes surgical repair of an abnormal or injured blood vessel in a lower extremity. This operative code captures services that restore vessel integrity or re-establish perfusion in arterial or venous structures of the leg. Nationally, procedures represented by this code are significant because they address limb-threatening ischemia, traumatic vascular injury, and other acute or chronic vascular conditions that can affect morbidity and resource use. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, a summary of payer coverage considerations, commonly reported modifiers, and related administrative elements. The publication outlines national benchmarking themes, coding and billing considerations relevant to hospital and ambulatory surgical settings, and points of attention for claims processing. Data not available in the input is explicitly noted where applicable. This piece provides clinicians, billing professionals, and policy analysts with the essential information needed to identify the service, understand where it is performed, and recognize the payer landscape for CPT code 35226.

Billing Code Overview

CPT code 35226 describes the surgical repair of an abnormal or injured blood vessel in a lower extremity. This procedure involves operative techniques to restore vascular integrity, control hemorrhage, or re-establish blood flow in arteries or veins of the leg.

Service type: Surgical vascular repair of a lower extremity blood vessel
Typical site of service: Hospital operating room or ambulatory surgical center

Clinical Context

A typical patient is an adult presenting with symptomatic peripheral arterial disease (PAD) or traumatic injury to a lower extremity blood vessel such as the femoral or popliteal artery. The patient may report worsening claudication, rest pain, nonhealing ischemic ulcer, or present emergently after penetrating or blunt trauma with active hemorrhage or limb ischemia. Preoperative evaluation includes vascular imaging (arterial duplex ultrasound, CT angiography, or conventional angiography), medical optimization, and discussion of surgical risks.

In the operating room or vascular suite, the vascular surgeon performs open repair of the abnormal or injured lower extremity vessel (CPT 35226). The workflow includes general or regional anesthesia, surgical exposure of the affected vessel, control of proximal and distal flow, repair (primary repair, patch angioplasty, or interposition graft as indicated), hemostasis, and wound closure. Postoperative care includes limb perfusion monitoring, anticoagulation or antiplatelet management as indicated, wound care, and follow‑up vascular imaging to confirm patency and healing.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the repair required substantially greater work than typical due to complexity or extensive dissection.

Taxonomy Code	Specialty	Notes
208800000X	Vascular Surgery	Primary specialty performing open lower extremity vascular repairs.
208000000X	General Surgery	May perform vascular repairs in trauma or general surgical settings.
207VS0101X	Surgery, Vascular - Endovascular	Vascular/endovascular surgeons who may perform hybrid open repairs.
207K00000X	Surgery, Cardiovascular	Cardiac/vascular surgeons involved in complex peripheral arterial reconstruction.
2086S0125X	Emergency Medicine	Emergency physicians involved in initial resuscitation and triage for traumatic vascular injury.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.209`	Unspecified atherosclerosis of native arteries of the extremities, unspecified extremity	Atherosclerotic PAD causing ischemia that may require open vessel repair.
`I70.211`	Atherosclerosis of native arteries of the extremities with intermittent claudication, right leg	Presents with exertional leg pain and may progress to require surgical intervention.
`I70.212`	Atherosclerosis of native arteries of the extremities with intermittent claudication, left leg	Same as above for the left side.
`I70.23`	Atherosclerosis of native arteries of the extremities with rest pain	Severe PAD indication for urgent revascularization or repair.
`I80.1`	Phlebitis and thrombophlebitis of femoral vein	Venous conditions can coexist; relevant when mixed arterial/venous pathology or trauma is present.
`S75.811A`	Laceration without foreign body of right femoral artery, initial encounter	Traumatic arterial injury requiring immediate surgical repair.
`S75.812A`	Laceration without foreign body of left femoral artery, initial encounter	Traumatic arterial injury on the left side requiring repair.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute limb ischemia from embolus/thrombus that may necessitate open arterial repair or thrombectomy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`34401`	Repair of blood vessel, neck, incision and repair; direct repair	Similar open vascular repair technique; relevant for analogies in documentation and coding of vessel repairs.
`35631`	Arterial bypass, with vein; femoral-popliteal, above knee, single segment	Performed when repair is not feasible and bypass is required for revascularization of the lower extremity.
`35351`	Thrombectomy, open, peripheral artery	Performed before or with repair when thrombus removal is required to restore flow.
`35800`	Revision, repair, or reconstruction of vascular access (hemodialysis); under local anesthesia	Represents vascular repair principles; may be performed in patients with access-related ischemia.
`36147`	Introduction of needle and catheter, with radiological supervision and interpretation; arterial, lower extremity, diagnostic angiography	Preoperative diagnostic angiography commonly performed to define lesion anatomy prior to open repair.

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Summary & Overview

CPT 35226: Repair of Lower Extremity Blood Vessel