CPT 35266 Upper‑Extremity Repair Reimbursement | OpenPayer

Summary & Overview

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

CPT code 35266 represents surgical repair of an abnormal or injured blood vessel in an upper extremity using a non–venous graft. This vascular surgery code captures procedures where non‑venous conduit is used to reconstruct arterial continuity in the arm or hand, a service that can be clinically necessary after trauma, aneurysm repair, or iatrogenic injury. Nationally, the code matters for hospital and surgical billing, specialty vascular reimbursement, and claims adjudication for upper‑extremity vascular reconstructions. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service and typical sites of service, payer coverage context, and what to expect in terms of coding classification. The publication also outlines benchmark considerations, coding nuances, and policy or coverage updates that commonly affect payment and authorization for upper‑extremity arterial repairs using non‑venous grafts. Data not available in the input is noted where applicable, and clinical context is provided to help coders and billing professionals align documentation with the procedure described by CPT code 35266.

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Billing Code Overview

CPT code 35266 describes a surgical repair of an abnormal or injured blood vessel in an upper extremity using a non–venous graft. This procedure involves reconstruction of an arterial structure in the arm or hand when native vein tissue is not used for the repair.

Service type: Surgical vascular repair with non-venous graft
Typical site of service: Operating room or surgical suite in a hospital or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A 58-year-old male construction worker presents to the emergency department after a deep laceration to the volar forearm from a workplace accident with active pulsatile bleeding and an expanding hematoma. Vascular surgery evaluates the patient and documents loss of palpable radial and ulnar pulses distal to the wound, cool pale hand, and motor/sensory deficits consistent with acute limb ischemia. Initial resuscitation and imaging (duplex ultrasound or CT angiography) confirm a transection of a brachial artery segment with inadequate local vein for primary repair. The patient is taken urgently to the operating room for exploration and repair. The surgeon performs resection of the injured arterial segment and reconstruction using a non-venous prosthetic graft to restore arterial continuity and distal perfusion. Typical workflow includes preoperative consent, anesthesia evaluation (general or regional), intraoperative monitoring of distal perfusion, graft selection and sizing, completion angiography or Doppler assessment, and postoperative monitoring in a surgical ward or step-down unit. Expected site of service is an operating room in an acute care hospital or ambulatory surgery center when clinically appropriate. The service type is open vascular repair with non-venous graft of an upper extremity arterial injury using CPT 35266.

Coding Specifications

Modifier	Description	When to Use
`26`

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

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

CPT 35251: Intra-abdominal Vessel Repair with Vein Graft

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

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

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

CPT 35236: Upper-Extremity Arterial Repair with Vein Graft

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

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

CPT-35221-ABDOMINAL-VESSEL-REPAIR

CPT 35221: Abdominal Blood Vessel Repair

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

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

CPT-35256-LOWER-EXTREMITY-ARTERIAL-REPAIR-WITH-VEIN-GRAFT

CPT 35256: Lower Extremity Blood Vessel Repair with Vein Graft

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Taxonomy Code	Specialty	Notes
`220000000X`	Vascular Surgery	Primary specialty performing open arterial graft repairs of upper extremity vessels.
`207R00000X`	Orthopedic Surgery of the Upper Extremity	May be involved when complex upper extremity trauma requires combined orthopedic and vascular management.
`208000000X`	General Surgery	General surgeons with vascular expertise may perform this repair in some hospitals.
`363A00000X`	Interventional Cardiology/Vascular Interventional Specialist	May be involved for intraoperative endovascular adjuncts or hybrid procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S45.011A`	Contusion of right brachial artery, initial encounter	Represents traumatic arterial injury of the brachial artery that may require surgical repair with grafting.
`S45.012A`	Contusion of left brachial artery, initial encounter	Left-sided equivalent for traumatic arterial injury requiring repair.
`S45.111A`	Laceration without foreign body of right brachial artery, initial encounter	Direct traumatic laceration commonly treated with arterial reconstruction such as `CPT 35266`.
`S45.112A`	Laceration without foreign body of left brachial artery, initial encounter	Left-sided laceration code relevant to surgical repair with graft.
`I74.3`	Embolism and thrombosis of arteries of upper extremity	Acute occlusive events that may necessitate exploration, thrombectomy, and possible bypass or grafting.
`T82.4XXA`	Complication of vascular graft, initial encounter	Relevant when addressing graft failure or infection that may require revision or replacement with non-venous graft.
`I70.2`	Atherosclerosis of native arteries of the extremities	Chronic arterial disease that can rarely involve upper extremity and necessitate bypass grafting when symptomatic.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35030`	Exploration and repair of traumatic wound of brachial artery; with direct repair (not graft)	Alternative operative approach when vessel can be repaired primarily without grafting; may be considered if vein available for patch or primary repair.
`35301`	Exploration of vessel with thrombectomy, upper extremity	Performed when arterial injury results in thrombus requiring embolectomy or thrombectomy in addition to repair.
`36245`	Selective catheter placement, arterial system; each first order thoracic branch, with angiography	Used intraoperatively or preoperatively for diagnostic angiography of the upper extremity arterial tree.
`36011`	Introduction of needle or catheter into peripheral artery for angiography, each artery	Used for diagnostic angiographic access relevant to vascular repair planning.
`75952`	Angiography, extremity, radiological supervision and interpretation	Reporting of the imaging study that documents vessel injury and graft patency intra- or postoperatively.
`99100`	Anesthesia for patient of extreme age, under 1 year or over 70 years, requiring special care	May be reported when anesthesia meets criteria; supportive service commonly reported with complex vascular surgery.

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