CPT 35510 Carotid‑to‑Brachial Bypass Reimbursement | OpenPayer

Summary & Overview

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.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareCPT 35510vascular surgeryarterial bypasscarotid-brachial bypassvein graftoperating roominpatient surgeryvascular care

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

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`

CPT 35522: Axillary-to-Brachial Vein Bypass

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

CPT 35556: Femoral to Popliteal Vein Bypass Graft

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

CPT 35508: Carotid-to-Vertebral Artery Bypass Graft

CPT-35537-AORTO-ILIAC-BYPASS-VEIN-GRAFT

CPT 35537: Aorto‑iliac Bypass with Vein Graft

CPT-35538-AORTO-ILIAC-VEIN-BYPASS

CPT 35538: Aorto-Iliac Bypass with Vein Graft

CPT-35571-POPLITEAL-TO-TIBIAL-PERONEAL-BYPASS

CPT 35571: Popliteal to Tibial/Peroneal Arterial Bypass

CPT-35525-BRACHIAL-ARTERY-BRACHIAL-ARTERY-VEIN-BYPASS-GRAFT

CPT 35525: Brachial Artery-to-Brachial Artery Vein Bypass

CPT-35521-AXILLARY-TO-FEMORAL-VEIN-BYPASS

CPT 35521: Axillary-to-Femoral Vein Bypass

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

CPT 35540: Aorto‑bifemoral Vein Bypass Graft

CPT-35539-AORTO-FEMORAL-VEIN-BYPASS-GRAFT

CPT 35539: Aorto-Femoral Vein Bypass Graft

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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.

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