CPT 35522 Axillary-to-Brachial Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35522: Axillary-to-Brachial Vein Bypass

CPT code 35522 represents an axillary-to-brachial arterial bypass using a vein graft to circumvent occlusive disease in the upper extremity. The procedure restores distal perfusion when native arterial segments are obstructed and is performed by vascular surgeons in operative settings. Nationally, such revascularization procedures are clinically important for limb salvage, symptom relief, and preservation of upper-extremity function.

Key payers commonly covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies and prior authorization requirements vary by payer and plan, influencing site-of-service decisions and utilization patterns.

This publication provides a concise overview of CPT code 35522, with readers learning the clinical context and typical service setting, common payer coverage considerations, and where to find further details on policy language and billing guidance. Benchmarking and payer-specific policy updates are summarized where available. Data not available in the input is identified explicitly, and readers will find clear references to what information is present versus missing.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35522axillary-to-brachial bypassvascular surgeryupper extremity revascularizationvein graftsurgical procedureoperating roomprocedure codingmedical billing

Billing Code Overview

CPT code 35522 describes a surgical revascularization procedure in which the surgeon bypasses a vascular occlusion by creating a bypass graft from the axillary artery to a portion of the brachial artery using a vein graft. The procedure is a form of upper-extremity arterial bypass intended to restore blood flow distal to a blockage.

Service type: Surgical vascular bypass using autologous vein graft
Typical site of service: Operating room or inpatient surgical suite, often performed by vascular surgery specialists

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old man with progressive ischemic rest pain and nonhealing forearm ulcers of the left upper extremity due to atherosclerotic occlusive disease of the axillary-brachial arterial segment. He presents after failed endovascular attempts or when vessel anatomy is unsuitable for angioplasty. Preoperative evaluation includes arterial duplex, CT angiography of the upper extremity and thoracic outlet, cardiopulmonary clearance, and venous mapping for autogenous conduit. On the day of surgery the patient is taken to an operating room with vascular surgery support. Under regional block or general anesthesia, the surgeon exposes the axillary artery proximally and a brachial artery distally, harvests a segment of autologous vein (commonly the greater saphenous or upper extremity vein), creates proximal and distal anastomoses, and tunnels the graft to bypass the occluded segment. Intraoperative completion angiography or duplex is often performed to confirm flow. Postoperative care includes monitoring in a surgical recovery unit or step-down unit, wound care, anticoagulation management, and surveillance duplex at follow-up to assess graft patency. Typical site of service: hospital operating room; typical service type: open major vascular reconstructive surgery (axillo-brachial bypass using vein graft).

Coding Specifications

Modifier	Description	When to Use
`00`	Default - no modifier	Use when no billing modifier is applicable for the service.

CPT 35512: Subclavian-to-Brachial Artery Vein Bypass

CPT-35560-RENAL-ARTERY-BYPASS-VEIN-GRAFT

CPT 35560: Aorta-to-Renal Artery Bypass Using Vein Graft

CPT-35506-CAROTID-TO-SUBCLAVIAN-BYPASS-GRAFT

CPT 35506: Carotid-to-Subclavian Bypass Graft

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

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

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

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

CPT-35501-CAROTID-COMMON-TO-INTERNAL-ARTERY-BYPASS-GRAFT

CPT 35501: Carotid Common-to-Internal Artery Bypass Graft

CPT-35523-BRACHIAL-TO-ULNAR-OR-RADIAL-VEIN-BYPASS

CPT 35523: Brachial to Ulnar or Radial Vein Bypass

CPT-35518-AXILLARY-ARTERY-TO-AXILLARY-ARTERY-BYPASS-VEIN-GRAFT

CPT 35518: Axillary-to-Axillary Artery Bypass with Vein Graft

CPT-35539-AORTO-FEMORAL-VEIN-BYPASS-GRAFT

CPT 35539: Aorto-Femoral Vein Bypass Graft

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

CPT 35556: Femoral to Popliteal Vein Bypass Graft

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Taxonomy Code	Specialty	Notes
2080S	Vascular Surgery	Primary specialty performing axillo-brachial bypass procedures.
2084S	Thoracic and Cardiac Surgery	May perform complex proximal axillary exposures or combined reconstructions.
207K00000X	General Surgery	Vascular-trained general surgeons perform peripheral bypass procedures.
208000000X	Surgery - Cardiothoracic	Involved when proximal axillary access or thoracic outlet considerations exist.
363L00000X	Interventional Radiology	Performs preoperative imaging and possible intraoperative completion angiography.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35631`	External iliac to femoral artery bypass, with vein graft (separate distal anastomosis)	Similar peripheral bypass technique; illustrates vein graft conduit harvesting and anastomotic technique analogous to axillo-brachial bypass.
`34841`	Thoracic aorta to axillary artery bypass	Proximal inflow alternatives when axillary inflow must be augmented; may be performed in complex reconstructions.
`36415`	Collection of venous blood by venipuncture	Preoperative blood draws for labs and crossmatch commonly performed prior to major vascular surgery.
`76937`	Ultrasound guidance for vascular access (e.g., intraoperative duplex)	Used for intraoperative duplex or guidance for conduit harvest and flow assessment.
`33010`	Thoracotomy; for access to axillary/inflow vessels (example code for thoracic access)	May be required when proximal control or access requires thoracic exposure in complex cases.

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