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    OpenPayerBilling CodesVein Bypass Graft ProceduresCPT cpt-35506-carotid-to-subclavian-bypass-graft
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    CPT 35506: Carotid to Subclavian Bypass Graft

    Medicare pays $1157 on average nationally for this procedure.

    CPT code 35506 describes surgical bypass of a blood vessel blockage by creating a graft from the common carotid artery to the subclavian artery, a vascular surgical procedure typically performed in an operating room or other inpatient/ambulatory surgical setting to restore blood flow to the upper extremity or vertebrobasilar circulation.

    For related coverage guidance, see recent payer policy updates: Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure, Cardiology - Ivabradine, Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA).

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    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.

    Related CPT Codes

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

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208D00000X
    2084P0800X
    1835C0206X
    103TA0700X
    3747A0650X
    246QM0706X
    231HA2400X
    343800000X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    G45.1Carotid artery syndrome (hemispheric)
    G45.9Transient cerebral ischemic attack, unspecified
    I63.50Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery
    I63.9Cerebral infarction, unspecified
    I65.21Occlusion and stenosis of right carotid artery
    I65.22Occlusion and stenosis of left carotid artery
    I65.23Occlusion and stenosis of bilateral carotid arteries
    I65.29Occlusion and stenosis of unspecified carotid artery
    I66.9Occlusion and stenosis of unspecified cerebral artery
    I67.2Cerebral atherosclerosis

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Cardiology1 / 2

    10 rows

    PolicyPayerEffective Date
    Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood PressureBluecross Idaho2026-11-01
    Cardiology - IvabradineCigna2026-10-15
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Percutaneous Ventricular Assist DeviceUnitedHealthcare2026-10-01
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Left Atrial Appendage Closure Devicesexcellus_health_plan_inc2026-09-17
    Left Atrial Appendage Closure Devicesuniverahealthcare2026-09-17
    Cardiac Omnibus CodesCigna2026-09-15

    Related Codes

    CPT-35500-ARM-VEIN-HARVEST-FOR-BYPASS-CONDUIT

    CPT 35500: Upper Extremity Vein Harvest for Bypass Conduit

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

    CPT 35501: Carotid Bypass, Common to Internal Carotid Artery

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

    CPT 35508: Carotid-to-Vertebral Artery Bypass Graft

    CPT-35509-CAROTID-TO-CAROTID-VEIN-BYPASS-GRAFT

    CPT 35509: Carotid-to-Carotid Vein Bypass Graft

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

    CPT 35510: Carotid-to-Brachial Vein Bypass Graft

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

    CPT 35511: Subclavian-to-Subclavian Vein Bypass Graft

    CPT-35512-SUBCLAVIAN-TO-BRACHIAL-ARTERY-VEIN-BYPASS

    CPT 35512: Subclavian-to-Brachial Artery Bypass with Vein Graft

    CPT-35515-SUBCLAVIAN-TO-VERTEBRAL-ARTERY-BYPASS-VEIN-GRAFT

    CPT 35515: Subclavian to Vertebral Artery Bypass with Vein Graft

    CPT-35516-SUBCLAVIAN-TO-AXILLARY-VEIN-BYPASS

    CPT 35516: Subclavian to Axillary Vein Bypass Graft

    CPT-35518-AXILLARY-ARTERY-TO-AXILLARY-ARTERY-BYPASS-VEIN-GRAFT

    CPT 35518: Axillary-to-Axillary Artery Bypass with Vein Graft

    Showing 1–10 of 32

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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