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    OpenPayerBilling CodesVein Bypass Graft ProceduresCPT cpt-35518-axillary-artery-to-axillary-artery-bypass-vein-graft
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    CPT 35518: Axillary-to-Axillary Artery Bypass with Vein Graft

    Medicare pays $1036 on average nationally for this procedure.

    CPT code 35518 describes surgical creation of an axillary-to-axillary arterial bypass using a vein graft to bypass an occluded blood vessel; this procedure is a vascular bypass graft service typically performed in an operating room or other inpatient or outpatient surgical setting and involves harvesting and anastomosis of a vein conduit to restore upper extremity arterial 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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient with progressive upper extremity ischemia due to chronic axillary artery occlusive disease presents with worsening claudication, rest pain, and nonhealing hand ischemic changes. After diagnostic workup including arterial duplex ultrasound and computed tomography angiography confirming a long-segment occlusion of the right axillary artery not amenable to endovascular recanalization, vascular surgery schedules an open axilloaxillary bypass using an autologous vein graft (CPT 35518). The clinical workflow includes preoperative medical optimization (antiplatelet therapy, cardiac risk assessment), informed consent discussing graft options and risks, harvesting of the autogenous vein conduit (typically great saphenous or arm vein), exposure of both axillary arteries, creation of proximal and distal anastomoses, graft tunneling and flow assessment, wound closure, and postoperative monitoring in PACU with vascular checks and anticoagulation as indicated. Typical site of service is an inpatient or hospital-based outpatient surgical setting (operating room) with possible admission for observation or inpatient care for complex comorbidity or revascularization monitoring.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    32551Tube thoracostomy, with or without water seal; insertion, includes drainage when requiredMay be performed if chest extension or pleural entry occurs during tunneling or exposure near thoracic inlet.
    35476Extra-anatomic bypass, axillofemoral — bypass grafting from axillary artery to femoral arteryAlternative extra-anatomic bypass option when axilloaxillary bypass is not appropriate; represents related revascularization strategies.
    36831Open surgical treatment of aneurysm or dissection of peripheral arteries; bypass graft, with vein graft, brachial to distal vessels (example)Represents comparable peripheral bypass techniques using autogenous vein conduit; similar coding principles for vein grafting.
    36415Collection of venous blood by venipunctureCommon preoperative laboratory sampling prior to vascular surgery.
    36556Insertion of non-tunneled centrally inserted central venous catheterMay be used perioperatively for hemodynamic monitoring or administration of vasoactive medications in complex patients.

    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…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207R00000X
    207L00000X
    207K00000X
    3336N0007X
    225000000X
    225XG0600X
    1835G0303X
    261QA1903X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    E11.51Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
    E78.5Hyperlipidemia, unspecified
    G45.8Other transient cerebral ischemic attacks and related syndromes
    G45.9Transient cerebral ischemic attack, unspecified
    I65.21Occlusion and stenosis of right carotid artery
    I65.22Occlusion and stenosis of left carotid artery
    I65.23Occlusion and stenosis of bilateral carotid arteries
    I66.01Occlusion and stenosis of right middle cerebral artery
    I66.02Occlusion and stenosis of left middle cerebral artery
    I66.09Occlusion and stenosis of unspecified middle cerebral artery

    Showing 1–10 of 26

    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-35515-SUBCLAVIAN-TO-VERTEBRAL-ARTERY-BYPASS-VEIN-GRAFT

    CPT 35515: Subclavian to Vertebral Artery Bypass with Vein Graft

    CPT-35516-SUBCLAVIAN-TO-AXILLARY-VEIN-BYPASS

    CPT 35516: Subclavian to Axillary Vein Bypass 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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