CPT 35523 Brachial-Upper Extremity Reimbursement | OpenPayer

Summary & Overview

CPT 35523: Brachial to Ulnar or Radial Vein Bypass

CPT code 35523 represents an open vascular bypass where a vein graft connects the brachial artery to the ulnar or radial artery to circumvent a distal upper-extremity arterial occlusion. This intervention is clinically important because it restores perfusion to the forearm and hand, preventing ischemic complications and potential limb loss. It is performed by vascular surgeons and is typically delivered in an operating room setting for symptomatic or critical ischemia.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, payer coverage considerations, and benchmarking elements relevant to national payment and utilization patterns. The publication outlines service definitions, typical sites of service, common billing modifiers, and where available, coding relationships that influence claims adjudication.

This summary equips clinicians, billing staff, and policy analysts with a clear description of the procedure and what to expect when reviewing claims or coverage policies at a national level. Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35523upper extremity bypassvascular surgeryvein graftbrachial arteryradial arteryulnar arteryoperating roomsurgical revascularization

Billing Code Overview

CPT code 35523 describes a surgical revascularization procedure in which the provider bypasses an arterial occlusion by inserting a vein graft that connects the brachial artery to a portion of the ulnar or radial artery. This procedure restores distal blood flow to the forearm and hand when native arterial segments are obstructed.

Service type: Open vascular bypass surgery using an autogenous vein graft.

Typical site of service: Inpatient hospital operating room or ambulatory surgical center, depending on patient acuity and facility capabilities.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with critical limb ischemia of the forearm presents with rest pain, non-healing digital ulcers, and diminished distal pulses after failed endovascular attempts to revascularize an occluded brachial-to-radial arterial segment. Angiography confirms a focal high-grade occlusion of the brachial artery with poor runoff into the radial artery. The vascular surgeon plans an open bypass using an autogenous vein graft to restore inflow to the radial or ulnar artery territory.

Preoperative workflow includes vascular laboratory noninvasive testing (arterial duplex, ankle/brachial indices adapted for the upper extremity as indicated), review of angiographic imaging, optimization of medical comorbidities (antiplatelet therapy, anticoagulation plan, diabetes and blood pressure control), informed consent, and marking of suitable conduit (cephalic or saphenous vein). Intraoperative steps include exposure of the brachial artery and target radial or ulnar artery, harvest and preparation of the vein graft, systemic or regional anesthesia, creation of proximal and distal anastomoses, graft patency assessment (intraoperative Doppler or completion angiography), and hemostasis. Postoperative care focuses on limb perfusion monitoring, pain control, wound care, anticoagulation/antiplatelet management, and outpatient follow-up with duplex surveillance.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the physician's professional interpretation is reported for an associated diagnostic study performed separately.

CPT 35535: Hepatic-to-Renal Artery Bypass with Vein Graft

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

CPT 35516: Subclavian-to-Axillary Vein Bypass

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

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

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

CPT 35539: Aorto-Femoral Vein Bypass Graft

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

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

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

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

CPT-35563-ILIAC-ARTERY-TO-ILIAC-ARTERY-VEIN-BYPASS

CPT 35563: Iliac-to-Iliac Artery Bypass with Vein Graft

CPT-35522-AXILLARY-TO-BRACHIAL-VEIN-BYPASS

CPT 35522: Axillary-to-Brachial Vein Bypass

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

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

CPT-35566-FEMORAL-TO-TIBIAL-PERONEAL-BYPASS

CPT 35566: Femoral-to-Tibial/Peroneal Arterial Bypass

Showing 1–10 of 32

Taxonomy Code	Specialty	Notes
207RP0000X	Vascular Surgery	Primary specialty performing open upper extremity arterial bypass procedures.
207RH0000X	Thoracic and Cardiovascular Surgery	Alternate specialty when performed by cardiothoracic vascular surgeons.
207T00000X	General Surgery	General surgeons with vascular training may perform this procedure in some settings.
204R00000X	Interventional Cardiology	May be involved in preoperative endovascular attempts or hybrid procedures.
208000000X	Radiology	Diagnostic and intraoperative imaging support (completion angiography), typically as consulting service.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.201`	Unspecified atherosclerosis of native arteries of extremities, right upper extremity	Atherosclerotic occlusive disease causing ischemia amenable to bypass.
`I70.202`	Unspecified atherosclerosis of native arteries of extremities, left upper extremity	Same as above for left-sided presentations.
`I70.233`	Atherosclerosis of native arteries of extremities with ulceration, bilateral upper extremities	Advanced disease with tissue loss indicating need for revascularization.
`I74.3`	Embolism and thrombosis of arteries of upper extremities	Acute or subacute arterial occlusion that may require bypass after failed embolectomy or when artery is unsuitable for endovascular repair.
`I96`	Gangrene, not elsewhere classified	Severe ischemia with tissue necrosis that can necessitate revascularization to salvage limb.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`10120`	Incision and drainage procedures for the upper extremity (skin, subcutaneous tissue, muscle) — code description representative of soft-tissue procedures	May be performed prior to or in conjunction with bypass when infected tissue or abscess requires drainage; ensure accurate selection if performed.
`35301`	Thromboendarterectomy, brachial artery (open)	Performed for localized plaque removal of the brachial artery; may be an alternative to or performed in conjunction with bypass depending on disease extent.
`34701`	Vein graft, autogenous, upper extremity (code description illustrative)	Represents vein graft harvesting and preparation; often reported in conjunction with bypass when harvesting separate conduit codes are required by payer policies.
`76000`	Fluoroscopy or imaging assistance (diagnostic catheterization)	Used when intraoperative angiography or fluoroscopic guidance is performed to confirm graft patency or guide the procedure.
`99152`	Moderate sedation services provided by the same physician performing a procedure (initial 15 minutes) — example code for anesthesia/monitoring	Reported when moderate sedation is used in addition to local/regional anesthesia during the bypass if payer allows separate reporting.

OpenPayer