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

CPT code 35510 denotes an arterial bypass procedure that connects the carotid artery to a portion of the brachial artery using a vein graft to circumvent an obstructed vessel. This complex vascular surgery is clinically significant for patients with proximal arterial occlusive disease when conventional repair or endovascular approaches are not feasible. Nationally, the procedure represents a high-acuity service with implications for surgical capacity, perioperative risk management, and postprocedural care pathways.

Key payers referenced in the analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. The publication provides a national perspective on coverage considerations and typical sites of service for this class of vascular bypass procedures.

Readers will learn the clinical context and service classification for CPT code 35510, typical care settings, and which major payers are included in the coverage review. The report also outlines where to find benchmarks and policy updates relevant to high-complexity vascular surgeries, and what clinical features commonly drive use of this procedure. Data not available in the input are noted where applicable.

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Billing Code Overview

CPT code 35510 describes a surgical bypass procedure in which the provider creates a bypass graft connecting the carotid artery to a portion of the brachial artery using a vein graft to circumvent a vascular blockage. This procedure is a form of arterial bypass surgery intended to restore blood flow when obstructions prevent normal circulation through the affected vessel.

Service type: Surgical vascular bypass (arterial bypass with vein graft)

Typical site of service: Inpatient or outpatient hospital operating room; vascular surgery center

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

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Get alerted when payer policies referencing 35510 are released or updated.

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Billing Code Overview

Service type: Surgical vascular bypass (arterial bypass with vein graft)

Typical site of service: Inpatient or outpatient hospital operating room; vascular surgery center

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient with progressive, symptomatic cerebrovascular insufficiency due to severe occlusive disease of the carotid artery presents with recurrent transient ischemic attacks and diminished cerebral perfusion on vascular imaging. Noninvasive testing (duplex ultrasound and CT angiography) demonstrates high-grade stenosis or occlusion of the carotid artery with inadequate collateral circulation. The vascular surgery team evaluates the patient and determines that direct carotid revascularization is not feasible or has failed; the decision is made to perform a carotid–brachial bypass using an autogenous vein graft to restore inflow to the ipsilateral upper extremity arterial circulation and augment cerebral perfusion.

The clinical workflow includes preoperative vascular laboratory studies, cardiopulmonary risk assessment, informed consent, operative planning with selection of suitable vein conduit (typically greater saphenous vein), general anesthesia with intraoperative neuromonitoring as indicated, surgical exposure of the carotid artery and brachial artery, harvesting and preparation of the vein graft, anastomosis creation to bypass the carotid lesion, hemostasis, wound closure, and postoperative monitoring in an intensive care or step-down setting with antiplatelet therapy and duplex surveillance prior to discharge. Typical site of service is an inpatient hospital operating room; this is a major vascular reconstructive procedure requiring hospitalization and postoperative monitoring.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Use when no specific modifier applies and service is performed as billed.
`11`	Office/OP E/M typical, or as CMS denotes — primary service	Use when this procedure is the primary service performed during the encounter if payer requests a primary-service indicator (some payers use `11`).
`22`	Increased procedural services	Use when work, time, or intensity substantially exceeds typical expectations for carotid–brachial bypass; documentation must support increased work.
`26`	Professional component	Use if billing facility separately bills for technical component and a physician bills the professional component (rare for this operative code).
`50`	Bilateral procedure	Use if bilateral carotid–brachial bypass procedures are performed in the same operative session (very uncommon).
`52`	Reduced services	Use when the procedure is partially reduced or was attempted but not completed as normally described.
`53`	Discontinued procedure	Use when the surgery is started but discontinued due to extenuating circumstances documented in the record.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the bypass procedure.
`66`	Surgical team (major operations)	Use when a surgical team approach is used for complex vascular reconstruction requiring a team of surgeons.
`78`	Unplanned return to OR for a related procedure during the postoperative period	Use if the patient returns to the operating room for revision or control of bleeding related to the initial bypass within the global period.
`80`	Assistant surgeon	Use when a surgical assistant is present and billable for assisting with the bypass.
`81`	Minimum assistant surgeon	Use when a physician assistant or other qualified assistant provides limited assistance as defined by payer rules.
`82`	Assistant surgeon (when qualified resident not available)	Use when an assistant is required but a qualified resident is not available.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician acts as an assistant during the bypass and the payer recognizes this modifier.

Taxonomy Code	Specialty	Notes
2080S0001X	Vascular Surgery	Primary specialty performing carotid–brachial bypass and other complex arterial reconstructions.
208000000X	General Surgery	General surgeons with vascular training may perform major peripheral bypass procedures.
207P00000X	Interventional Cardiology / Vascular Medicine	Physicians involved in preoperative vascular assessment and perioperative medical optimization.
207L00000X	Thoracic and Cardiac Surgery	Rarely involved when concomitant proximal thoracic vessel pathology requires cardiac surgical expertise.
363L00000X	Vascular & Interventional Radiology	Often provides preoperative endovascular evaluation and postoperative imaging support.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I65.21`	Occlusion and stenosis of right carotid artery	High-grade carotid occlusive disease causing ischemia; primary indication for carotid bypass procedures when endarterectomy or stenting is not feasible.
`I65.22`	Occlusion and stenosis of left carotid artery	Same clinical relevance for left-sided disease requiring bypass.
`I63.9`	Cerebral infarction, unspecified	Ischemic stroke related to carotid occlusive disease; may prompt revascularization to prevent further events.
`G45.9`	Transient cerebral ischemic attack, unspecified	TIAs from carotid stenosis that can indicate need for definitive revascularization.
`I70.2`	Atherosclerosis of native arteries of the extremities	Concomitant peripheral atherosclerotic disease that may be present in patients undergoing arterial bypass procedures.
`I74.3`	Embolism and thrombosis of arteries of the lower extremities	Thromboembolic complications that can be related to proximal arterial disease and may influence operative planning.
`I77.2`	Rupture of aneurysm of artery, non-specified site	Vascular pathology that may coexist in complex cases requiring specialized vascular surgical management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35512`	Bypass graft, with vein; axillary artery to femoral artery (or vice versa) — example peripheral arterial bypass codes	Related large-vessel bypass codes used in peripheral arterial reconstruction; conceptually similar conduit harvesting and anastomosis techniques.
`34410`	Transposition of cervical vessels; carotid artery	Performed when alternative carotid reconstruction or transposition is considered instead of a bypass.
`35563`	Revision or repair of vascular graft; major peripheral arteries	Used when postoperative graft revision or thrombectomy is required for the carotid–brachial bypass graft.
`37607`	Vein harvest, open, for autogenous graft (saphenous vein), unilateral	Often billed when a separate vein-harvest site is documented for the autogenous conduit used in bypass.
`36215`	Selective catheter placement, arterial system; each first order thoracic arch branch, with angiography	Preoperative or intraoperative diagnostic angiography to map arterial inflow/outflow prior to bypass.

CPT 35500: Upper-Extremity Vein Harvest for Bypass Conduit

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

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

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

CPT 35506: Carotid-to-Subclavian Bypass Graft

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 Bypass with Vein 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 Vein Bypass

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

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

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Use when no specific modifier applies and service is performed as billed.
`11`	Office/OP E/M typical, or as CMS denotes — primary service	Use when this procedure is the primary service performed during the encounter if payer requests a primary-service indicator (some payers use `11`).
`22`	Increased procedural services	Use when work, time, or intensity substantially exceeds typical expectations for carotid–brachial bypass; documentation must support increased work.
`26`	Professional component	Use if billing facility separately bills for technical component and a physician bills the professional component (rare for this operative code).
`50`	Bilateral procedure	Use if bilateral carotid–brachial bypass procedures are performed in the same operative session (very uncommon).
`52`	Reduced services	Use when the procedure is partially reduced or was attempted but not completed as normally described.
`53`	Discontinued procedure	Use when the surgery is started but discontinued due to extenuating circumstances documented in the record.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the bypass procedure.
`66`	Surgical team (major operations)	Use when a surgical team approach is used for complex vascular reconstruction requiring a team of surgeons.
`78`	Unplanned return to OR for a related procedure during the postoperative period	Use if the patient returns to the operating room for revision or control of bleeding related to the initial bypass within the global period.
`80`	Assistant surgeon	Use when a surgical assistant is present and billable for assisting with the bypass.
`81`	Minimum assistant surgeon	Use when a physician assistant or other qualified assistant provides limited assistance as defined by payer rules.
`82`	Assistant surgeon (when qualified resident not available)	Use when an assistant is required but a qualified resident is not available.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician acts as an assistant during the bypass and the payer recognizes this modifier.

Taxonomy Code	Specialty	Notes
2080S0001X	Vascular Surgery	Primary specialty performing carotid–brachial bypass and other complex arterial reconstructions.
208000000X	General Surgery	General surgeons with vascular training may perform major peripheral bypass procedures.
207P00000X	Interventional Cardiology / Vascular Medicine	Physicians involved in preoperative vascular assessment and perioperative medical optimization.
207L00000X	Thoracic and Cardiac Surgery	Rarely involved when concomitant proximal thoracic vessel pathology requires cardiac surgical expertise.
363L00000X	Vascular & Interventional Radiology	Often provides preoperative endovascular evaluation and postoperative imaging support.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I65.21`	Occlusion and stenosis of right carotid artery	High-grade carotid occlusive disease causing ischemia; primary indication for carotid bypass procedures when endarterectomy or stenting is not feasible.
`I65.22`	Occlusion and stenosis of left carotid artery	Same clinical relevance for left-sided disease requiring bypass.
`I63.9`	Cerebral infarction, unspecified	Ischemic stroke related to carotid occlusive disease; may prompt revascularization to prevent further events.
`G45.9`	Transient cerebral ischemic attack, unspecified	TIAs from carotid stenosis that can indicate need for definitive revascularization.
`I70.2`	Atherosclerosis of native arteries of the extremities	Concomitant peripheral atherosclerotic disease that may be present in patients undergoing arterial bypass procedures.
`I74.3`	Embolism and thrombosis of arteries of the lower extremities	Thromboembolic complications that can be related to proximal arterial disease and may influence operative planning.
`I77.2`	Rupture of aneurysm of artery, non-specified site	Vascular pathology that may coexist in complex cases requiring specialized vascular surgical management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35512`	Bypass graft, with vein; axillary artery to femoral artery (or vice versa) — example peripheral arterial bypass codes	Related large-vessel bypass codes used in peripheral arterial reconstruction; conceptually similar conduit harvesting and anastomosis techniques.
`34410`	Transposition of cervical vessels; carotid artery	Performed when alternative carotid reconstruction or transposition is considered instead of a bypass.
`35563`	Revision or repair of vascular graft; major peripheral arteries	Used when postoperative graft revision or thrombectomy is required for the carotid–brachial bypass graft.
`37607`	Vein harvest, open, for autogenous graft (saphenous vein), unilateral	Often billed when a separate vein-harvest site is documented for the autogenous conduit used in bypass.
`36215`	Selective catheter placement, arterial system; each first order thoracic arch branch, with angiography	Preoperative or intraoperative diagnostic angiography to map arterial inflow/outflow prior to bypass.

CPT 35500: Upper-Extremity Vein Harvest for Bypass Conduit

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

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

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

CPT 35506: Carotid-to-Subclavian Bypass Graft

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 Bypass with Vein 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 Vein Bypass

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

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

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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

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Billing Code Overview

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

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References