Summary & Overview
CPT 35515: Subclavian-to-Vertebral Artery Bypass with Vein Graft
CPT code 35515 denotes a surgical arterial bypass in which a vein graft connects the subclavian artery to a portion of the vertebral artery to bypass an occlusion and re-establish vertebral circulation. The procedure is a specialized vascular revascularization intervention performed in an operating room, typically for patients with symptomatic vertebrobasilar ischemia or traumatic/occlusive lesions compromising vertebral artery inflow. Nationally, this code represents high-acuity vascular surgery with implications for surgical capacity, perioperative risk management, and payer coverage policies. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, guidance on common billing considerations, and where available, benchmark references and policy updates relevant to coverage and medical necessity. The publication outlines expected service settings, procedural components, and common modifiers used with the code. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 35515 describes a surgical arterial bypass procedure in which the provider bypasses a blood vessel blockage by inserting a bypass graft that connects the subclavian artery to a portion of the vertebral artery using a vein graft. This procedure is a vascular surgical revascularization intended to restore blood flow to the vertebral circulation when proximal arterial occlusive disease or injury impairs perfusion.
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Service type: Surgical arterial bypass using a vein graft
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Typical site of service: Inpatient or hospital operating room setting for vascular surgery, often performed by vascular or cardiothoracic surgeons
Clinical & Coding Specifications
Clinical Context
A typical patient is a 65-year-old male with symptomatic vertebrobasilar insufficiency caused by severe occlusive disease of the proximal vertebral artery and subclavian steal physiology. He reports recurrent dizziness, syncope-like episodes, and transient ischemic symptoms despite optimal medical therapy including antiplatelet agents and risk-factor control. Noninvasive imaging (CT angiography or duplex ultrasonography) and confirmatory digital subtraction angiography demonstrate a high-grade stenosis or occlusion of the vertebral artery origin not amenable to endovascular angioplasty/stenting due to anatomic considerations or prior failed attempts.
The vascular surgery or cardiothoracic surgery team schedules an open extra-anatomic bypass procedure: harvesting a suitable autogenous vein graft (commonly the great saphenous vein), exposing the subclavian artery proximally and the vertebral artery more distally, then creating an interposition graft anastomosis from the subclavian artery to the vertebral artery to re-establish antegrade vertebral flow. The procedure is performed in an operating room with general anesthesia, continuous neurovascular monitoring as indicated, and vascular surgical instrumentation. Typical perioperative workflow includes preoperative imaging review, anesthesia induction, graft harvest, arterial exposures, graft anastomoses, hemostasis, and postoperative ICU or step-down monitoring for neurologic status and limb perfusion.
Typical site of service: Inpatient operating room or major ambulatory surgical center when medically appropriate. Service type: Open vascular bypass surgery (extra-anatomic arterial bypass).
Coding Specifications
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