Summary & Overview
CPT 35516: Subclavian-to-Axillary Vein Bypass
CPT code 35516 identifies a surgical arterial bypass that connects the subclavian artery to a segment of the axillary artery using a vein graft to bypass an occlusion. Nationally, this code represents a specialized vascular surgery used to restore upper-extremity perfusion when endovascular options are unsuitable or have failed. It is clinically significant for vascular surgery, cardiothoracic surgery, and trauma practices and has implications for hospital surgical services and reimbursement for complex vascular procedures.
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, typical sites of service, commonly reported modifiers, and the payer mix relevant to national benchmarking. The publication highlights where to expect variability in coding and site-of-care designations and outlines which stakeholders—surgeons, hospitals, and payers—are most directly affected by claims for this service.
The content that follows presents benchmarks, coding guidance, and policy considerations at a national level, along with practical information to support accurate claim submission and administrative handling of complex vascular bypass procedures. Data not available in the input will be noted explicitly where relevant.
Billing Code Overview
CPT code 35516 describes a surgical bypass procedure in which the provider creates a conduit around an occluded subclavian artery by connecting the subclavian artery to a portion of the axillary artery using a vein graft. This procedure is a form of arterial bypass targeted at restoring blood flow to the upper extremity when native arterial segments are obstructed.
Service type: Surgical arterial bypass using vein graft
Typical site of service: Operating room (inpatient or outpatient surgical setting)
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a history of peripheral artery disease and symptomatic left upper extremity ischemia presents with progressive arm claudication, resting pain, and diminished radial pulse. Noninvasive vascular testing and CT angiography demonstrate a high-grade occlusion of the proximal left subclavian artery proximal to the vertebral origin. After multidisciplinary vascular surgery and vascular medicine evaluation, the patient is scheduled for an open subclavian-to-axillary bypass using an autogenous vein graft because endovascular options are unsuitable due to long-segment occlusion and vessel tortuosity.
Preoperative workflow includes pre-anesthesia evaluation, consent for open bypass, venous mapping for conduit harvest, and perioperative antibiotics. Intraoperative steps include general anesthesia, exposure of the subclavian artery and axillary artery via supraclavicular and infraclavicular incisions as needed, harvest of ipsilateral greater saphenous or arm vein, systemic heparinization, creation of proximal anastomosis to the subclavian artery, tunneling of the vein graft, distal anastomosis to the axillary artery, flow assessment, and hemostasis. Postoperative care includes vascular monitoring of pulses and limb perfusion, wound care, antiplatelet therapy, and duplex ultrasound surveillance prior to discharge.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no other modifier applies |