CPT 35525 Brachial Artery Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35525: Brachial Artery-to-Brachial Artery Vein Bypass

CPT code 35525 denotes a surgical vascular bypass that connects one brachial artery to the contralateral brachial artery using a vein graft to bypass a vessel occlusion. The procedure is clinically significant for limb- and arm-preserving revascularization in patients with critical ischemia or symptomatic arterial blockage when endovascular options are not suitable. Nationally, this code represents advanced peripheral arterial reconstructive surgery performed in inpatient or outpatient surgical settings.

Key payers relevant to national billing and coverage include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, service and site expectations, and the payers commonly involved in coverage decisions.

This publication provides benchmarks and policy-oriented details tied to billing practices, clinical indications, and coding context for CPT code 35525. It summarizes reimbursement and utilization considerations, highlights common documentation elements necessary to support medical necessity, and outlines how the procedure fits within vascular surgery service lines. Data not available in the input is clearly identified where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35525brachial artery bypassvascular surgeryvein graftperipheral revascularizationsurgical procedureoperating roomambulatory surgery

Billing Code Overview

CPT code 35525 describes a surgical bypass procedure in which the provider bypasses a blood vessel blockage by inserting a bypass graft that connects the brachial artery to the other brachial artery using a vein graft. This is a vascular surgery bypass of the brachial artery performed to restore arterial blood flow around an occluded or diseased segment.

Service type: Surgical vascular bypass procedure
Typical site of service: Hospital operating room or ambulatory surgical center, depending on clinical status and facility capabilities

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with end-stage renal disease and long-standing peripheral arterial disease presents with severe ischemic rest pain and non-healing ulcers of the distal forearm and hand. Noninvasive vascular studies and arteriography demonstrate an occlusive lesion of the brachial artery in the mid–upper arm with inadequate distal runoff. The vascular surgeon plans an extra-anatomic upper extremity bypass where a reversed autogenous vein graft is tunneled to create a brachial-to-brachial bypass around the occlusion (CPT 35525).

Preoperative workflow includes history and physical, review of noninvasive vascular testing (duplex ultrasound, ABIs), diagnostic angiography in the interventional suite, vein mapping to identify suitable autogenous conduit (cephalic or basilic vein), medication reconciliation (antiplatelet/anticoagulant management), and informed consent addressing limb salvage goals and risks. Intraoperative workflow involves general or regional anesthesia, surgical exposure of proximal and distal brachial arteries, harvest/preparation of the vein graft, creation of proximal and distal anastomoses, graft tunnel creation, and flow assessment. Postoperative care includes monitoring in PACU or step-down for perfusion checks, wound care, anticoagulation management, and scheduled duplex surveillance for graft patency.

Coding Specifications

Provide the most applicable modifiers and provider taxonomies relevant to upper extremity bypass surgery (CPT 35525).

Modifier	Description	When to Use

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

CPT-35509-CAROTID-TO-CAROTID-VEIN-BYPASS-GRAFT

CPT 35509: Carotid-to-Carotid Bypass with Vein Graft

CPT-35511-SUBCLAVIAN-ARTERY-TO-SUBCLAVIAN-ARTERY-VEIN-BYPASS

CPT 35511: Subclavian-to-Subclavian Vein Bypass Graft

CPT-35570-TIBIAL-PERONEAL-ARTERY-BYPASS

CPT 35570: Tibial and Peroneal Artery Bypass Procedures

CPT-35538-AORTO-ILIAC-VEIN-BYPASS

CPT 35538: Aorto-Iliac Bypass with Vein Graft

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

CPT 35506: Carotid-to-Subclavian Bypass Graft

CPT-35571-POPLITEAL-TO-TIBIAL-PERONEAL-BYPASS

CPT 35571: Popliteal to Tibial/Peroneal Arterial Bypass

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

CPT 35556: Femoral to Popliteal Vein Bypass Graft

CPT-35512-SUBCLAVIAN-TO-BRACHIAL-ARTERY-VEIN-BYPASS

CPT 35512: Subclavian-to-Brachial Artery Vein Bypass

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

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

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Taxonomy Code	Specialty	Notes
207RG0400X	Vascular Surgery	Primary specialty performing upper extremity arterial bypass procedures.
208600000X	Cardiothoracic & Vascular Surgery	Surgeons with combined expertise in complex arterial reconstructions.
207XS0106X	General Surgery	General surgeons with vascular training may perform bypasses in some settings.
2080P0208X	Interventional Radiology/Endovascular Surgery	May perform diagnostic angiography and endovascular adjuncts; not typical for open `35525`.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.209`	Atherosclerosis of native arteries of the upper extremity, unspecified, without rest pain	A common cause of brachial artery occlusion leading to ischemic symptoms addressed by bypass.
`I70.219`	Atherosclerosis of native arteries of the upper extremity, unspecified, with rest pain	Presents with rest pain indicating limb ischemia necessitating revascularization.
`I70.229`	Atherosclerosis of native arteries of the upper extremity, unspecified, with ulceration	Non-healing ulcers of the hand/forearm often prompt surgical bypass for limb salvage.
`I74.3`	Embolism and thrombosis of arteries of upper extremities	Acute or subacute embolic occlusion treated with revascularization procedures.
`T82.828A`	Embolism and thrombosis of other vascular prosthetic devices, implants and grafts, initial encounter	Relevant when prior prosthetic grafts have thrombosed and require revision or bypass.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36147`	Introduction of catheter, arterial, brachial, with diagnostic angiography	Performed preoperatively for diagnostic angiography of the brachial circulation to define level of occlusion.
`36415`	Collection of venous blood by venipuncture	Used for preoperative labs including crossmatch and baseline tests.
`35390`	Bypass graft, other vessel, with vein; with subcutaneous tunneling	Codes for peripheral arterial bypass procedures of other anatomic sites; may be considered in related coding scenarios (use of vein conduit).
`36215`	Selective catheter placement, arterial; each first order thoracic/ upper extremity branch, radiological supervision and interpretation	Used during diagnostic or interventional angiography to selectively evaluate upper extremity vessels.
`93925`	Duplex scan of arterial inflow and outflow, upper extremity, complete bilateral study	Preoperative and postoperative noninvasive surveillance of graft and arterial inflow/outflow.

`26`	Professional component	When reporting only the physician’s professional component for a service with a distinct technical component (rare for this operative code).
`50`	Bilateral procedure	When identical procedures are performed on both upper extremities during the same operative session.
`51`	Multiple procedures	When `CPT 35525` is reported with additional distinct procedures during the same operative session and multiple-procedure rules apply.
`52`	Reduced services	When the service performed is reduced or not completed as described by the full code.
`53`	Discontinued procedure	When the procedure is started but terminated due to extenuating circumstances or patient condition prior to completion.
`54`	Surgical care only	When reporting only the surgical portion because another clinician furnished pre/postoperative care.
`55`	Postoperative management only	When the physician furnishes only postoperative care.
`62`	Two surgeons	When two surgeons with distinct skills work together as primary surgeons performing portions of the procedure.
`78`	Return to OR for related procedure during global period	When an unplanned return to the operating room for a related procedure occurs during the global period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	(Not in supplied list) — Data not available in the input.
`22`	Increased procedural services	When work required to perform the procedure is substantially greater than typically required.
`23`	Unusual anesthesia	When general anesthesia is precluded and the procedure is performed under unusual circumstances requiring anesthesia that would otherwise be general.
`62`	Two surgeons	(duplicate entry avoided)

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