CPT 35512 Subclavian-to-Brachial Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35512: Subclavian-to-Brachial Artery Vein Bypass

CPT code 35512 represents an open vascular bypass where a vein graft connects the subclavian artery to a segment of the brachial artery to circumvent an occlusive lesion and reestablish arterial flow to the arm. This surgical revascularization procedure matters nationally as a treatment for critical limb ischemia of the upper extremity and for preserving limb function when endovascular options are unsuitable.

Payers commonly involved in coverage and reimbursement for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure, typical sites of service, and the kinds of operational and billing considerations associated with an open upper extremity arterial bypass. The publication outlines benchmarks and reimbursement patterns where available, summarizes relevant coding relationships, and highlights areas of policy or coverage nuance that affect payment and utilization. Clinical implications, including indications for surgical bypass versus endovascular therapy and expected care settings, are described to inform coding, billing, and administrative decision-making for national audiences.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35512CPTvascular-surgeryupper-extremity-bypasssubclavian-arterybrachial-arteryvein-graftsurgical-procedure

Billing Code Overview

CPT code 35512 describes a surgical arterial bypass procedure in which the provider creates a bypass graft connecting the subclavian artery to a portion of the brachial artery using a vein graft to bypass an obstructed vessel. This procedure is performed to restore arterial blood flow to the upper extremity when native arterial circulation is compromised by occlusion or severe stenosis.

Service type: Surgical arterial bypass (upper extremity vascular bypass)
Typical site of service: Inpatient or outpatient surgical setting, commonly performed in an operating room with vascular surgery capabilities

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of peripheral arterial disease and progressive ischemic symptoms of the right upper extremity presents with rest pain, digital ischemia, and nonhealing fingertip ulcers despite optimal medical therapy and endovascular attempts. Diagnostic imaging (duplex ultrasound and angiography) demonstrates a high-grade occlusive lesion of the right subclavian artery proximal to the vertebral takeoff with inadequate inflow to the brachial artery. The vascular surgery team decides to perform an open extra-anatomic bypass: creation of a subclavian-to-brachial artery bypass using an autologous vein graft to restore distal perfusion.

Preoperative workflow includes cardiopulmonary assessment, informed consent documenting the bypass and graft source, and marking of the vein harvest site. Intraoperative steps include exposure of the subclavian artery, harvest and preparation of the vein graft (typically ipsilateral or contralateral greater saphenous or upper extremity vein), tunneling of the graft to the brachial artery, proximal and distal anastomoses, hemostasis, and assessment of flow (palpable pulses, Doppler signals). Postoperative management includes monitoring for graft patency, anticoagulation or antiplatelet therapy per institutional protocol, wound care, and surveillance duplex imaging during follow-up.

Coding Specifications

Modifier	Description	When to Use
`00`	Modifier not recognized for Medicare/other payors (placeholder standard)

CPT 35523: Brachial to Ulnar or Radial Vein Bypass

CPT-35566-FEMORAL-TO-TIBIAL-PERONEAL-BYPASS

CPT 35566: Femoral-to-Tibial/Peroneal Arterial Bypass

CPT-35565-ILIAC-TO-FEMORAL-VEIN-BYPASS

CPT 35565: Iliac-to-Femoral Vein Graft Bypass

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

CPT 35511: Subclavian-to-Subclavian Vein Bypass Graft

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

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

CPT-35563-ILIAC-ARTERY-TO-ILIAC-ARTERY-VEIN-BYPASS

CPT 35563: Iliac-to-Iliac Artery Bypass with Vein Graft

CPT-35526-AORTO-SUBCLAVIAN-INNOMINATE-CAROTID-VEIN-BYPASS

CPT 35526: Aorto-Subclavian/Innominate/Carotid Vein Bypass

CPT-35533-AXILLOFEMORAL-BYPASS-VEIN-GRAFT-BILATERAL

CPT 35533: Axillofemoral Bypass Using Vein Graft, Bilateral

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

CPT 35556: Femoral to Popliteal Vein Bypass Graft

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

CPT 35537: Aorto‑iliac Bypass with Vein Graft

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Taxonomy Code	Specialty	Notes
207L00000X	Vascular Surgery	Primary specialty performing open subclavian-to-brachial bypass.
207SG0200X	Thoracic and Cardiac Surgery	May perform supra-aortic and subclavian reconstructions in some centers.
207P00000X	General Surgery	Vascular-trained general surgeons perform peripheral bypass procedures.
2080P0207X	Interventional Cardiology	Typically performs endovascular alternatives; may be part of hybrid procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.219`	Atherosclerosis of native arteries of the extremities, right leg unspecified	Atherosclerotic occlusive disease is a common cause of subclavian and brachial inflow compromise necessitating bypass.
`I70.229`	Atherosclerosis of native arteries of the extremities, left leg unspecified	Contralateral disease may be present; systemic atherosclerosis context.
`I74.3`	Embolism and thrombosis of arteries of upper extremities	Acute embolic occlusion may mandate bypass or thrombectomy in addition to revascularization.
`I73.9`	Peripheral vascular disease, unspecified	Broad code capturing chronic limb ischemia indications for upper extremity revascularization.
`G45.9`	Transient cerebral ischemic attack, unspecified	Subclavian stenosis proximal to vertebral artery can contribute to vertebrobasilar insufficiency in some patients (consideration in surgical planning).

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35512`	Bypass graft, with vein; subclavian to brachial	Primary procedure restoring arterial inflow to the upper extremity by vein graft (subject code).
`35631`	Bypass graft, venae comitantes or other, upper extremity; brachial to radial or ulnar artery	Performed when distal bypass extension or additional distal revascularization is required.
`35600`	Thrombectomy or embolectomy, with or without arteriotomy; upper extremity	Performed if intraoperative thrombosis or embolus requires removal to salvage graft or native artery.
`36147`	Introduction of catheter into artery, other than central (e.g., diagnostic angiography of limb)	Preoperative or intraoperative angiography or access procedures for localization and planning.
`37799`	Unlisted procedure, vascular surgery	Used for unusual or adjunct vascular procedures not described by specific CPT codes during the same operative session.
`93925`	Duplex scan of upper extremity arterial/venous mapping and postoperative surveillance	Used preoperatively for mapping vessels or postoperatively to assess graft patency.

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