CPT 35355 Iliofemoral Thrombectomy Reimbursement | OpenPayer

Summary & Overview

CPT 35355: Iliofemoral Artery Thrombectomy and Plaque Removal

CPT code 35355 identifies a vascular procedure for removal of thrombus and atherosclerotic plaque from the iliofemoral arterial segment. This procedure is a key intervention for restoring arterial blood flow in patients with acute or chronic iliofemoral occlusive disease and can have substantial implications for limb salvage, perioperative resource use, and hospital-based vascular service lines. Nationally, utilization of this code reflects practice patterns in vascular surgery and interventional radiology across hospital inpatient and outpatient settings.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common sites of service, and the procedural intent for 35355. The publication also summarizes benchmarks and payment considerations where available, highlights relevant clinical implications for care teams, and notes available data limitations. Data not available in the input is identified explicitly. The content is intended for national stakeholders including hospital administrators, vascular specialists, coding and billing professionals, and policy analysts who need a clear reference on how CPT code 35355 is used and classified.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35355CPTiliofemoral thrombectomyvascular surgeryendovascular proceduresarterial plaque removalhospital inpatienthospital outpatientprocedure coding

Billing Code Overview

CPT code 35355 describes a procedure in which the provider removes thrombus and atherosclerotic plaque from an iliofemoral artery. This is an endovascular or open vascular procedure aimed at restoring blood flow in the iliofemoral arterial segment.

Service type: Vascular thromboembolectomy/arterial plaque removal
Typical site of service: Hospital operating room or hospital-based interventional suite (inpatient or outpatient hospital setting)

Data not available in the input for associated taxonomies and ICD-10 diagnoses.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old male with progressive left lower-extremity claudication and nonhealing foot ulceration despite conservative therapy. Noninvasive vascular testing (ABI, duplex ultrasound) and CT angiography demonstrate an occlusive thrombus and atherosclerotic plaque involving the left common femoral and proximal external iliac arteries. The vascular surgery team schedules an operative endarterectomy/thrombectomy of the iliofemoral segment under general anesthesia in an operating room or hybrid endovascular suite. The workflow includes preoperative assessment, administration of prophylactic antibiotics, intraoperative arterial exposure of the iliofemoral segment, removal of thrombus and atheromatous plaque with Fogarty catheters and/or endarterectomy instruments, possible patch angioplasty or bovine/vein patch reconstruction, completion angiography to confirm reestablished flow, and postoperative monitoring in the PACU with vascular checks and anticoagulation management as indicated. Typical payors encountered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the surgeon's professional component separate from technical facility charges.
`50`

CPT 35341: Removal of Thrombus and Plaque from Mesenteric/Celiac/Renal Artery

CPT-35303-POPLITEAL-ARTERY-THROMBUS-PLAQUE-REMOVAL

CPT 35303: Popliteal Artery Thrombus and Plaque Removal

CPT-35363-AORTOILIOFEMORAL-ARTERY-THROMBUS-PLAQUE-REMOVAL

CPT 35363: Removal of Thrombus and Plaque from Aortoiliofemoral Artery

CPT-35351-ILIAC-ARTERY-THROMBUS-ENDARTERECTOMY

CPT 35351: Iliac Artery Thrombus and Plaque Removal

CPT-35321-AXILLARY-BRACHIAL-ARTERY-THROMBECTOMY-ENDARTERECTOMY

CPT 35321: Removal of Thrombus and Plaque from Axillary or Brachial Artery

CPT-35371-FEMORAL-ARTERY-THROMBECTOMY-ENDARTERECTOMY

CPT 35371: Common Femoral Artery Thrombectomy/Endarterectomy

CPT-35390-REOPERATIVE-CAROTID-THROMBUS-REMOVAL

CPT 35390: Reoperative Carotid Thrombus Removal After Endarterectomy

CPT-35361-AORTOILIAC-THROMBUS-PLAQUE-REMOVAL-WITH-GRAFT

CPT 35361: Aortoiliac Thrombus/Plague Removal with Graft Placement

CPT-35331-ABDOMINAL-AORTIC-THROMBECTOMY-ENDARTERECTOMY

CPT 35331: Removal of Thrombus and Plaque from Abdominal Aorta

35301-THROMBOENDARTERECTOMY-INCLUDING-PATCH-GRAFT-IF-PERFORMED

CPT 35301: Thromboendarterectomy of Carotid, Vertebral, or Subclavian Arteries

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Taxonomy Code	Specialty	Notes
207RP0000X	Vascular Surgery	Primary specialty performing open iliofemoral thrombectomy/endarterectomy.
207RG0300X	General Surgery	General surgeons with vascular expertise often perform this procedure.
2088S0122X	Interventional Cardiology	May be involved when hybrid endovascular approaches are used.
2084P0800X	Interventional Radiology	Performs diagnostic and adjunctive endovascular imaging and interventions in hybrid suites.
207L00000X	Thoracic and Cardiac Surgery	Occasionally involved for complex aortoiliac reconstructions requiring cardiothoracic expertise.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.219`	Atherosclerosis of native arteries of the extremities, unspecified extremity, with intermittent claudication	Common indication when iliofemoral plaque causes symptomatic limb ischemia requiring thrombus/plaque removal.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute embolic or thrombotic occlusion of iliofemoral arteries prompting thrombectomy.
`I70.231`	Atherosclerosis of native arteries of the extremities, right leg with rest pain	Severe peripheral arterial disease with rest pain indicating need for revascularization.
`I70.232`	Atherosclerosis of native arteries of the extremities, left leg with rest pain	Laterality-specific diagnosis often paired with `LT` modifier when left iliofemoral procedure performed.
`I70.241`	Atherosclerosis of native arteries of the extremities, right leg with ulceration	Chronic limb-threatening ischemia with ulceration requiring arterial reconstruction.
`I70.242`	Atherosclerosis of native arteries of the extremities, left leg with ulceration	Left-sided ulceration necessitating targeted iliofemoral thrombus/plaque removal.
`I96`	Gangrene, not elsewhere classified	Advanced ischemic complication sometimes present and necessitating urgent revascularization.
`R02`	Gangrene, unspecified	When documentation codes gangrenous changes as a complication of poor perfusion requiring arterial intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`37227`	Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel	May be performed instead of or in combination with open thromboendarterectomy when endovascular revascularization is chosen or as adjunct during hybrid repair.
`35351`	Thrombectomy, arterial, other than carotid, with or without thrombolysis, including catheter-directed thrombolytic infusion when performed; femoral-popliteal	Related lower-extremity arterial thrombectomy codes often performed for more distal thrombus; may be performed in same patient if thrombus extends.
`35476`	Thrombectomy, arterial, simple, with or without arteriotomy; femoral, popliteal, tibial, or peroneal	Represents thrombectomy of distal segments and may be billed when separate remote arterial thrombus removal is performed.
`36245`	Selective catheter placement, arterial system; each first order thoracic, abdominal vessel and branches, initial vessel	Used for intraoperative or preoperative diagnostic angiography to define lesion and guide intervention.
`36147`	Transcatheter therapy, intra-arterial occlusion, any method (eg, embolization, infusion), percutaneous or open	May be used for adjunctive intra-arterial therapies such as catheter-directed thrombolysis if performed concomitantly.
`74175`	CT angiography, abdomen and pelvis	Preoperative imaging study commonly obtained to delineate iliofemoral occlusive disease and plan surgery.

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