CPT 35231 Neck Vein Graft Reimbursement | OpenPayer

Summary & Overview

CPT 35231: Repair of Neck Blood Vessel with Vein Graft

CPT code 35231 denotes surgical repair of an abnormal or injured neck blood vessel using a vein graft, a specialized vascular reconstruction performed to re-establish arterial continuity and flow in cervical vessels. Nationally, this procedure is significant due to its role in preventing ischemic complications and managing traumatic or pathologic vascular lesions in the neck. Payers commonly covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find benchmarks and contextual information relevant to coverage and utilization, including typical sites of service (hospital operating room or inpatient surgical suite), clinical indications, and procedural context. The publication summarizes coding specifics for billing and documentation, outlines common payer considerations, and highlights where policy updates or prior authorization practices can affect access. It also provides clinical context about when a vein graft is preferred over primary repair or prosthetic conduit. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35231CPTvascular surgeryvein graftcarotid repairsurgical repairinpatient surgeryoperating room

Billing Code Overview

CPT code 35231 describes a surgical procedure in which the provider repairs an abnormal or injured blood vessel in the neck using a vein graft. This procedure is a vascular reconstructive operation performed to restore or improve blood flow in carotid or other cervical arteries when direct repair is not feasible.

Service type: Surgical vascular repair with vein graft
Typical site of service: Hospital operating room or inpatient surgical suite

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of hypertension and peripheral vascular disease presents with a rapidly expanding pulsatile mass in the right neck and symptoms of cerebral hypoperfusion (transient right arm weakness and dizziness). Imaging with CT angiography demonstrates a ruptured or severely injured right common carotid artery segment with a length of vessel unsuitable for primary repair. The vascular surgery team plans an urgent open arterial reconstruction under general anesthesia using an autologous vein graft (commonly great saphenous vein) to replace the damaged carotid segment and restore cerebral perfusion. The workflow includes preoperative evaluation (neurologic and vascular assessment, antiplatelet/anticoagulation planning), intraoperative arterial exposure and control of the carotid bifurcation, harvesting and preparation of the vein graft, end-to-end or interposition graft anastomosis, intraoperative duplex or angiography to confirm flow, and postoperative monitoring in a step-down or intensive care unit with neurologic checks and anticoagulation management.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical for the procedure (documentation required).
`23`

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

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

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

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

CPT 35251: Intra-abdominal Vessel Repair with Vein Graft

CPT-35276-INTRATHORACIC-VESSEL-REPAIR-NON-VENOUS-GRAFT-NO-BYPASS

CPT 35276: Intrathoracic Blood Vessel Repair with Non‑Venous Graft, No Bypass

CPT-35221-ABDOMINAL-VESSEL-REPAIR

CPT 35221: Abdominal Blood Vessel Repair

CPT-35236-UPPER-EXTREMITY-ARTERIAL-REPAIR-WITH-VEIN-GRAFT

CPT 35236: Upper-Extremity Arterial Repair with Vein Graft

CPT-35207-HAND-FINGER-VESSEL-REPAIR-CLOSURE

CPT 35207: Vessel Repair/Ligation, Hand or Finger

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

CPT-35281-INTRA-ABDOMINAL-VESSEL-REPAIR-NON-VENOUS-GRAFT

CPT 35281: Intra‑abdominal Vessel Repair with Non‑Venous Graft

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Taxonomy Code	Specialty	Notes
207VG0300X	Vascular Surgery	Primary specialty performing arterial reconstructions of the neck.
207R00000X	General Surgery	Often performs carotid and neck vascular repairs at some centers.
2080P0226X	Cardiothoracic Surgery	Performs complex central vascular repairs when thoracic extension or cardiopulmonary support is needed.
208100000X	Neurosurgery	May be involved for procedures with significant cerebrovascular or skull-base complexity.
363LF0000X	Interventional Cardiology/Vascular Medicine	Involved in pre- or postoperative endovascular imaging and adjunctive interventions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I72.9`	Aneurysm of artery, unspecified	Cervical arterial aneurysm or pseudoaneurysm requiring repair with vein graft.
`I77.6`	Arterial dissection, unspecified	Dissection of carotid or vertebral artery causing ischemia or rupture necessitating graft repair.
`I65.29`	Occlusion and stenosis of unspecified carotid artery	Severe carotid disease with vessel injury or need for interposition graft when endarterectomy not feasible.
`S15.9XXA`	Unspecified injury of neck, initial encounter	Traumatic injury to neck vessels requiring surgical repair with a vein graft.
`I74.3`	Embolism and thrombosis of arteries of upper extremity	Embolic complications from arterial injury in the neck that may prompt surgical vascular reconstruction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35102`	Radical neck dissection, unilateral	Performed when extensive exposure or oncologic resection requires concurrent vascular repair or access.
`35301`	Bypass graft, with vein; extracranial-intracranial arterial bypass	Performed for cerebral revascularization when additional bypasses are required to restore flow.
`36215`	Selective catheter placement, arterial system; each first-order thoracic branch, from aorta	Used for intraoperative or preoperative angiography to delineate neck vessel anatomy and plan repair.
`36247`	Introduction of catheter, arterial, lower extremity, for diagnostic angiography, with or without injection(s)	Used when peripheral angiography is required to map vein conduit or assess distal run-off (vein conduit evaluation).
`99499`	Unlisted evaluation and management service	Used rarely for reporting unusual perioperative services when no specific code applies; hospital policy dependent.

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