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    v1.0.30
    OpenPayerBilling CodesVein Bypass Graft ProceduresCPT cpt-35508-carotid-to-vertebral-bypass-graft
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    CPT 35508: Carotid-to-Vertebral Artery Bypass Graft

    Medicare pays $1210 on average nationally for this procedure.

    CPT code 35508 describes surgical creation of a bypass graft connecting the common carotid artery to a segment of the vertebral artery to circumvent an arterial occlusion; this is a vascular bypass procedure performed in an operating room or hybrid endovascular suite and is classified as an open vascular surgery service for the head and neck 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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with symptomatic posterior circulation ischemia due to proximal vertebral artery occlusion or severe stenosis not amenable to endovascular repair. The patient often presents with recurrent vertebrobasilar transient ischemic attacks (dizziness, diplopia, ataxia) or stroke despite optimal medical therapy. Diagnostic workup includes vascular imaging (CTA, MRA, or digital subtraction angiography) confirming a proximal vertebral artery lesion and assessment of carotid and subclavian anatomy to determine suitability for a carotid-to-vertebral bypass.

    The clinical workflow begins with preoperative evaluation by a vascular surgeon or neurosurgeon including neurologic assessment, cardiac clearance, and discussion of risks. Perioperative planning includes cross-sectional and catheter angiography to map donor (common carotid) and recipient (vertebral) targets. In the operating room under general anesthesia, the surgeon exposes the common carotid artery and the vertebral artery segment, harvests or prepares a suitable graft (autologous vein or prosthetic), and constructs the bypass graft from the common carotid artery to the vertebral artery to restore posterior circulation flow. Postoperative care involves neurologic monitoring, antiplatelet or anticoagulation management, surveillance duplex or CTA, and rehabilitation as indicated.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    61645External carotid artery to posterior circulation bypass (hypoglossal-facial bypass not otherwise classified) — Note: placeholder for specialized cranial bypass codesData not available in the input.
    36215Selective catheter placement, vertebral artery, unilateral, with angiography; radiological supervision and interpretationCommonly performed preoperatively for diagnostic digital subtraction angiography to delineate vertebral lesions and collateral flow.
    36216Selective catheter placement, bilateral vertebral arteries, with angiography; radiological supervision and interpretationUsed when bilateral vertebral imaging is required for operative planning.
    35301Bypass graft, femoral-popliteal, single segment; this is an example of peripheral bypass technique codingRepresents conceptually similar bypass graft techniques; not the same anatomic site but relevant to graft selection and technique coding.
    31725Ligation of thoracic great vessel (example thoracic vascular procedure)Represents related thoracic vascular procedures sometimes necessary in complex multilevel reconstructions.

    Note: If a related CPT code list was provided in the input it would be listed above. The table above identifies commonly associated diagnostic angiography and conceptually related bypass procedure codes used in preoperative or adjunctive care workflows.

    Related Modifiers

    11 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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    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…
    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…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207RP1001X
    2086X0206X
    2471C3402X
    133VN1401X
    163WM0102X
    146M00000X
    3747P1801X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    E78.5Hyperlipidemia, unspecified
    G45.1Carotid artery syndrome (hemispheric)
    G45.8Other transient cerebral ischemic attacks and related syndromes
    G45.9Transient cerebral ischemic attack, unspecified
    I10Essential (primary) hypertension
    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

    Showing 1–10 of 24

    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-35506-CAROTID-TO-SUBCLAVIAN-BYPASS-GRAFT

    CPT 35506: Carotid to Subclavian 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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