CPT 35261 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

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

CPT code 35261 denotes surgical repair of an abnormal or injured neck blood vessel using a non–venous graft. This vascular reconstructive procedure is clinically significant because it addresses traumatic or pathological defects in cervical arteries or large neck vessels where vein grafts are not used or available. Nationally, the procedure impacts resource utilization in hospital operating rooms, perioperative vascular care pathways, and specialty surgical services.

Key payers included in the coverage analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and payer coverage considerations. The publication provides benchmarks where available, highlights relevant policy and coding updates affecting surgical vascular procedures, and explains billing considerations tied to the code’s clinical indications.

Content is aimed at billing managers, coding professionals, and clinical leaders seeking a clear summary of what CPT code 35261 represents, typical clinical settings, and the payer landscape for reimbursement and coverage policy. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35261vascular surgeryneck vessel repairgraftoperative procedurehospital inpatienthospital outpatientsurgical codingprocedure coding

Billing Code Overview

CPT code 35261 describes surgical repair of an abnormal or injured blood vessel in the neck using a non–venous graft. This procedure involves reconstruction of a cervical arterial or large vessel defect with a graft material that is not harvested from the patient's veins.

Service type: Open vascular surgical repair with graft placement
Typical site of service: Inpatient or outpatient hospital operating room, often within vascular surgery or otolaryngology operative settings

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of hypertension and peripheral vascular disease presents with a symptomatic high-grade carotid artery stenosis after an episode of transient ischemic attack (TIA). Imaging with duplex ultrasound and CT angiography demonstrates an injured or diseased extracranial carotid artery segment requiring surgical repair. The vascular surgeon elects to perform open repair of the abnormal cervical blood vessel using a non‑venous prosthetic graft because the native vein is unsuitable. The typical clinical workflow includes preoperative vascular imaging, perioperative medical optimization, general anesthesia in an operating room or hybrid vascular suite, surgical exposure of the carotid artery in the neck, resection or repair of the diseased segment, interposition of a non‑venous graft (e.g., Dacron or PTFE), intraoperative assessment of flow (doppler/angiography), postoperative monitoring in a PACU or step‑down unit, and follow‑up imaging to confirm graft patency.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Use when no specific modifier applies.
`11`	Surgical procedure was the primary procedure

CPT 35231: Repair of Neck Blood Vessel with Vein Graft

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

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

CPT-35226-LOWER-EXTREMITY-VASCULAR-REPAIR

CPT 35226: Repair of Lower Extremity Blood Vessel

CPT-35286-LOWER-EXTREMITY-NON-VENOUS-GRAFT-REPAIR

CPT 35286: Lower Extremity Blood Vessel Repair with Non‑Venous Graft

CPT-35216-THORACIC-VESSEL-REPAIR-OPEN-WITHOUT-BYPASS

CPT 35216: Open Thoracic Vessel Repair Without Cardiopulmonary Bypass

CPT-35201-NECK-VESSEL-REPAIR-SUTURE-REPAIR

CPT 35201: Neck Vessel Repair with Suture

CPT-35221-ABDOMINAL-VESSEL-REPAIR

CPT 35221: Abdominal Blood Vessel Repair

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

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

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

CPT 35236: Upper-Extremity Arterial Repair with Vein Graft

CPT-35211-INTRATHORACIC-VESSEL-REPAIR-CARDIOPULMONARY-BYPASS

CPT 35211: Repair of Ruptured Intrathoracic Vessel with Cardiopulmonary Bypass

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Taxonomy Code	Specialty	Notes
2080S	Vascular Surgery	Primary specialty performing open carotid and cervical vessel repairs.
207RG0300X	General Surgery	General surgeons with vascular training may perform neck vascular repairs.
207LH0000X	Thoracic Surgery	Thoracic/vascular surgeons involved in complex cervical great vessel repairs.
208100000X	Cardiovascular Surgery	Cardiovascular surgeons engaged for complex grafting and arterial reconstruction.
363A00000X	Interventional Cardiology/Vascular	May be involved in hybrid cases with endovascular adjuncts (intraoperative angiography).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I65.21`	Occlusion and stenosis of left carotid artery	High-grade carotid stenosis necessitating repair or grafting.
`I65.22`	Occlusion and stenosis of right carotid artery	Right-sided carotid disease requiring surgical repair.
`I72.3`	Aneurysm of artery of head and neck	Aneurysmal disease of cervical vessels that may require resection and grafting.
`I74.3`	Embolism and thrombosis of arteries of the lower extremities (example arterial embolism code)	Embolic phenomena can originate from cervical vessel pathology; included when embolic source is cervical artery.
`S15.0`	Injury of carotid artery	Traumatic injury to a cervical vessel requiring repair with non‑venous graft.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35266`	Repair of injured or diseased blood vessel; with vein graft, neck	Alternative technique using autogenous vein graft when vein is available instead of non‑venous graft.
`35301`	Arterial reconstruction, other than carotid, with interposition graft; external iliac to femoral, etc. (example code for vascular graft technique)	Related reconstructive vascular grafting technique; relevant for coding similar graft procedures and technique familiarity.
`36215`	Selective catheter placement, arterial system; each first order thoracic branch, or carotid; with radiological supervision and interpretation	Used if intraoperative catheter angiography or selective angiography is performed to document vessel repair.
`76937`	Ultrasound guidance for vascular access (procedural)	Used if ultrasound guidance is used for central or arterial access during the procedure or monitoring of flow.
`31575`	Laryngoscopy, direct, with biopsy or removal of foreign body; including tracheostomy if required (example airway procedures)	May be performed if airway control is complex or a tracheostomy is required in perioperative management.

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