Summary & Overview
CPT 35306: Additional Tibial or Peroneal Artery Thromboendarterectomy
CPT code 35306 denotes removal of thrombus or plaque from an additional tibial or peroneal artery performed during the same operative session as a separately reportable thromboendarterectomy on the initial tibial or peroneal artery. This add-on surgical code captures instances when multiple tibial or peroneal arteries are treated in one encounter and is important for accurate clinical documentation, coding, and national utilization tracking for peripheral vascular surgical care.
Key national payers included in this review are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent and service setting, common billing modifiers and payer considerations, and the typical operational context when the code is reported. The publication outlines benchmarks for use and coding practices where available and highlights clinical context relevant to peripheral arterial thromboendarterectomy procedures.
This summary is written for a national audience and provides clarity on the code’s purpose, typical sites of service, and what to expect in payer coverage discussions and billing workflows. Data not available in the input are noted where applicable in the full publication.
Billing Code Overview
CPT code 35306 describes removal of thrombus or plaques from an additional tibial or peroneal artery performed in the same session as a separately reportable thromboendarterectomy of the initial tibial or peroneal artery. The code represents each additional tibial or peroneal artery treated during that same procedure.
-
Service type: Peripheral vascular surgical procedure (additional tibial or peroneal artery thromboendarterectomy)
-
Typical site of service: Hospital operating room or outpatient surgical center where peripheral vascular surgical procedures are performed.
Clinical & Coding Specifications
Clinical Context
A typical patient is an older adult with critical limb ischemia or acute limb-threatening ischemia secondary to thromboembolic occlusion or progressive atherosclerotic plaque in the distal calf arteries. The patient presents with rest pain, non-healing foot ulcer, or acute ischemic changes such as pallor, pain, pulselessness, and paresthesia. After noninvasive vascular testing (ankle-brachial index, arterial duplex) and angiographic confirmation of tibial or peroneal obstruction, the vascular surgery or interventional radiology team performs an open thromboendarterectomy on the primary tibial or peroneal artery. During the same operative session, the provider identifies an additional occluded tibial or peroneal artery requiring removal of thrombus or plaque; 35306 is reported for that additional artery.
Preoperative workflow includes vascular imaging review, anesthesia pre-op assessment, and consent for limb revascularization. Intraoperative workflow includes exposure of the tibial/peroneal arteries, arteriotomy, thromboendarterectomy of the primary artery, then sequential treatment of the additional artery or arteries. Postoperative workflow includes limb perfusion assessment, wound care, anticoagulation or antiplatelet management as indicated, and follow-up vascular studies to confirm patency.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, preoperative status |