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    OpenPayerBilling CodesVein Bypass Graft ProceduresCPT cpt-35515-subclavian-to-vertebral-artery-bypass-vein-graft
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    CPT 35515: Subclavian to Vertebral Artery Bypass with Vein Graft

    Medicare pays $1210 on average nationally for this procedure.

    CPT code 35515 describes surgical bypass of a blood vessel blockage by inserting a vein graft connecting the subclavian artery to a portion of the vertebral artery; this is an arterial bypass (revascularization) procedure typically performed as an open vascular surgery in an inpatient or hospital-based operating room setting to restore posterior cerebral or upper extremity blood flow.

    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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    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).

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    93010Electrocardiogram, routine ECG with at least 12 leads; interpretation and report onlyPreoperative cardiac evaluation and perioperative monitoring interpretation
    36140Arterial catheterization, percutaneous; non-selective, initial, any methodDiagnostic arterial access/angiography preceding open bypass when performing intraoperative angiography
    36147Arterial catheterization, open percutaneous, with diagnostic angiography, each vesselUsed for diagnostic angiography of great vessels in planning or hybrid procedures
    33533Coronary artery bypass, venous graft, single coronary venous graftExample of autogenous vein graft harvesting technique; conceptually related graft use (different anatomic site)
    35301Graft, arterial; interposition, graft; extra-anatomic graftsRelated open arterial graft techniques and coding for arterial interposition grafting
    99100Anesthesia for patient of extreme age, under 1 year or over 70 years, requiring specific monitoringPossible anesthesia add-on when elderly patient requires additional monitoring

    Related Modifiers

    8 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…
    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…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    363L00000X
    385HR2065X
    2085R0001X
    246Q00000X
    2083A0100X
    2251H1200X
    171WH0202X

    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-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 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-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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