CPT 35506 Carotid–Subclavian Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35506: Carotid-to-Subclavian Bypass Graft

CPT code 35506 represents an open surgical bypass that connects the common carotid artery to the subclavian artery to circumvent proximal arterial obstruction. This highly specialized vascular reconstructive procedure is performed to restore arterial inflow to the upper extremity or posterior cerebral circulation and is significant because it involves major operative risk, resource intensity, and coordination across vascular surgery and perioperative care teams. Nationally, 35506 is relevant to hospitals, vascular surgery groups, and payers due to its impact on surgical case-mix and episode cost.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent and typical care setting for the procedure, plus what to expect from associated billing and payer considerations. The publication outlines benchmarks and comparators where available, summarizes pertinent policy and reimbursement context, and situates the code within the broader clinical pathway for patients with proximal subclavian or carotid-subclavian occlusive disease. Data not provided in the input—such as specific ICD-10 mappings, utilization statistics, and associated taxonomies—is noted as unavailable and will not be inferred.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35506CPTvascular-surgerycarotid-subclavian-bypassbypass-graftoperative-procedurehospital-surgeryarterial-revascularization

Billing Code Overview

CPT code 35506 describes a surgical bypass procedure in which the provider creates a graft connecting the common carotid artery to a portion of the subclavian artery to bypass a vascular blockage. This operation is performed to restore or improve blood flow to the arm or vertebrobasilar circulation when proximal arterial disease prevents adequate perfusion.

Service type: Surgical vascular bypass grafting
Typical site of service: Hospital operating room or other acute-care surgical setting

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with symptomatic left upper extremity ischemia and vertebrobasilar insufficiency presents with progressive arm claudication, diminished left radial pulse, and recurrent dizziness. Imaging with duplex ultrasound and CT angiography demonstrates a high-grade proximal left subclavian artery occlusion proximal to the origin of the vertebral artery. The vascular surgery team elects to perform a carotid–subclavian bypass to restore antegrade flow to the left subclavian and vertebral circulations.

Preoperative workflow includes surgical consent, anesthesia evaluation, and perioperative medication review. In the operating room under general anesthesia, the surgeon exposes the common carotid artery and the targeted portion of the subclavian artery, harvests or prepares a prosthetic or vein graft, and creates end-to-side anastomoses to bypass the occlusion. Intraoperative monitoring may include arterial line placement and neurovascular checks. Postoperative care involves vascular monitoring, duplex ultrasound to confirm graft patency, pain control, and antiplatelet therapy. Typical recovery includes an inpatient stay for observation and wound care, with outpatient follow-up for surveillance imaging and functional assessment.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Standard reporting when no modifier applies

CPT 35516: Subclavian-to-Axillary Vein Bypass

CPT-35511-SUBCLAVIAN-ARTERY-TO-SUBCLAVIAN-ARTERY-VEIN-BYPASS

CPT 35511: Subclavian-to-Subclavian Vein Bypass Graft

CPT-35508-CAROTID-TO-VERTEBRAL-BYPASS-GRAFT

CPT 35508: Carotid-to-Vertebral Artery Bypass Graft

CPT-35538-AORTO-ILIAC-VEIN-BYPASS

CPT 35538: Aorto-Iliac Bypass with Vein Graft

CPT-35531-AORTO-VISCERAL-VEIN-BYPASS-GRAFT

CPT 35531: Aorto-to-Celiac/Mesenteric Vein Bypass Graft

CPT-35556-FEMORAL-TO-POPLITEAL-VEIN-BYPASS-GRAFT

CPT 35556: Femoral to Popliteal Vein Bypass Graft

CPT-35501-CAROTID-COMMON-TO-INTERNAL-ARTERY-BYPASS-GRAFT

CPT 35501: Carotid Common-to-Internal Artery Bypass Graft

CPT-35510-CAROTID-TO-BRACHIAL-ARTERY-BYPASS-VEIN-GRAFT

CPT 35510: Carotid-to-Brachial Artery Bypass with Vein Graft

CPT-35535-HEPATIC-TO-RENAL-ARTERY-BYPASS-VEIN-GRAFT

CPT 35535: Hepatic-to-Renal Artery Bypass with Vein Graft

CPT-35540-AORTO-BIFEMORAL-VEIN-BYPASS-GRAFT

CPT 35540: Aorto‑bifemoral Vein Bypass Graft

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Taxonomy Code	Specialty	Notes
2080P0200X	Vascular Surgery	Primary specialty performing carotid–subclavian bypass procedures
2080S0122X	Thoracic and Cardiac Surgery	Often involved when proximal subclavian or arch exposure requires thoracic expertise
208D00000X	General Surgery	May perform peripheral vascular bypass procedures in some centers
2084P0800X	Cardiothoracic Vascular Surgery	Specialized in complex great vessel reconstructions
207RX0400X	Interventional Cardiology	May be involved for preoperative endovascular evaluation or hybrid approaches

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.2`	Atherosclerosis of native arteries of the extremities	Primary cause of proximal subclavian occlusive disease requiring bypass
`I73.9`	Peripheral vascular disease, unspecified	General vascular insufficiency that can manifest as upper extremity ischemia prompting revascularization
`G45.9`	Transient cerebral ischemic attack, unspecified	Vertebrobasilar symptoms from subclavian steal physiology that may necessitate carotid–subclavian bypass
`I65.2`	Occlusion and stenosis of carotid artery	Coexisting carotid disease may be assessed concurrently in vascular workup
`I74.3`	Embolism and thrombosis of arteries of the upper extremities	Acute or chronic embolic disease that can be an indication for revascularization

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35301`	Thromboendarterectomy, including patch graft, when performed; subclavian artery	May be performed instead of or prior to bypass if lesion is amenable to endarterectomy
`35390`	Bypass graft, with or without replacement, other specified peripheral vascular procedures	Related peripheral bypass code; used for other upper extremity or arch branch bypasses not specifically coded as carotid–subclavian
`36215`	Selective catheter placement, arterial system; each first order thoracic branch, within a vascular family	Used for preoperative diagnostic angiography of the great vessels and subclavian artery
`93971`	Duplex scan of extracranial arteries; complete bilateral study	Preoperative and postoperative noninvasive surveillance of carotid and subclavian flow
`36140`	Introduction of needle and/or catheter into a central artery, with radiological supervision and interpretation	Used when intraoperative angiography or catheter-based assessment is performed during the procedure

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