CPT 35526 Aorto-Subclavian Vein Bypass Reimbursement | OpenPayer

Summary & Overview

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

CPT code 35526 denotes an open vascular bypass procedure connecting the aorta to a portion of the subclavian, innominate, or carotid artery using a vein graft. This code captures complex revascularization aimed at restoring arterial inflow to the head, neck, or upper extremity when native vessels are occluded or stenosed. Nationally, procedures coded under CPT 35526 are important due to their role in preventing ischemic complications and preserving neurologic and limb function, often requiring inpatient surgical resources and specialized vascular teams.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, common billing considerations, and expected payer coverage patterns. The publication also outlines benchmarks and utilization metrics where available, summarizes relevant policy updates that affect billing and prior authorization, and highlights documentation elements tied to clinical indication and operative complexity.

This summary is intended for billing managers, vascular surgeons, revenue cycle professionals, and policy analysts seeking a national view of how CPT code 35526 is used, reimbursed, and managed across major commercial and federal payers.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35526Vascular SurgeryAorto-subclavian BypassVein GraftInnominate Artery BypassCarotid Artery BypassSurgical ProcedureHospital InpatientAmbulatory Surgery

Billing Code Overview

CPT code 35526 describes a surgical arterial bypass procedure in which the provider bypasses a blood vessel blockage by inserting a bypass graft that connects the aorta to a portion of the subclavian, innominate, or carotid artery using a vein graft.

Service type: Open vascular bypass grafting of major upper-extremity or head/neck arterial inflow (aorto-subclavian/innominate/carotid vein graft).
Typical site of service: Hospital operating room or inpatient surgical suite for vascular surgery; may also occur in an ambulatory surgical center when clinically appropriate.

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with a history of peripheral arterial disease and symptomatic left upper extremity ischemia presents with progressive claudication, decreased hand perfusion, and recurrent syncopal episodes related to subclavian steal physiology. Noninvasive testing (duplex ultrasound and CTA) demonstrates a high-grade occlusive lesion of the proximal left subclavian artery proximal to the vertebral artery origin. The vascular surgery team elects to perform an aorto-subclavian bypass using a reversed autogenous greater saphenous vein graft to restore inflow to the left subclavian artery and reverse the steal.

Preoperative workflow includes anesthesia evaluation, informed consent documenting risks (bleeding, infection, stroke, myocardial infarction), and cross-sectional imaging review to plan proximal and distal anastomosis sites. In the operating room under general anesthesia, the surgeon exposes the infrarenal aorta via a limited retroperitoneal approach and the left subclavian artery via supraclavicular incision. A reversed saphenous vein is harvested, flushed, and tunneled; proximal anastomosis to the aorta and distal anastomosis to the subclavian artery are performed. Hemostasis is secured, wounds closed, and the patient is transferred to a monitored unit for recovery with antiplatelet therapy and routine postoperative surveillance (duplex) to assess graft patency.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard reporting

Related Codes

CPT-35558-FEMORAL-FEMORAL-VEIN-BYPASS

CPT 35558: Femoral–Femoral Bypass with Vein Graft

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

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

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

CPT 35539: Aorto-Femoral Vein Bypass Graft

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

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

CPT-35572-FEMOROPOPLITEAL-VEIN-HARVEST-FOR-VASCULAR-RECONSTRUCTION

CPT 35572: Femoropopliteal Vein Harvest for Vascular Reconstruction

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

CPT 35523: Brachial to Ulnar or Radial Vein Bypass

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

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

CPT-35536-SPLENIC-TO-RENAL-ARTERY-BYPASS-VEIN-GRAFT

CPT 35536: Splenic-to-Renal Artery Bypass with Vein Graft

CPT-35570-TIBIAL-PERONEAL-ARTERY-BYPASS

CPT 35570: Tibial and Peroneal Artery Bypass Procedures

CPT-35521-AXILLARY-TO-FEMORAL-VEIN-BYPASS

CPT 35521: Axillary-to-Femoral Vein Bypass

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Taxonomy Code	Specialty	Notes
207P00000X	Vascular Surgery	Primary specialty performing aorto-subclavian bypass grafting.
207K00000X	Thoracic Surgery	May perform procedures involving proximal aortic anastomosis and great vessel reconstructions.
207L00000X	Cardiothoracic Vascular Surgery	Specialists managing complex aortic and branch vessel bypass procedures.
2080P0010X	General Surgery	General surgeons with vascular training may perform peripheral arterial bypasses.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.2`	Atherosclerosis of native arteries of the extremities	Peripheral atherosclerotic disease leading to proximal subclavian occlusion and indication for bypass.
`I73.9`	Peripheral vascular disease, unspecified	Broad category capturing ischemic symptoms prompting surgical bypass.
`I65.29`	Occlusion and stenosis of other precerebral arteries	Relevant when proximal subclavian disease threatens cerebral perfusion and causes steal phenomena.
`I74.3`	Embolism and thrombosis of arteries of the lower extremity	Included when acute thrombosis affects inflow vessels and bypass is needed; less common for subclavian territory but relevant for thromboembolic disease.
`G45.9`	Transient cerebral ischemic attack, unspecified	Indicates neurologic symptoms (syncope, TIA) from subclavian steal that may prompt revascularization.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`33533`	Aortic valve replacement with cardiopulmonary bypass	May be contemporaneous when cardiac and great vessel procedures are required; supports complex thoracic operative planning.
`35631`	Thromboendarterectomy, with or without patch angioplasty, brachiocephalic trunk and/or subclavian artery	Performed when endarterectomy is indicated for plaque removal in the same vascular territory.
`37186`	Transcatheter placement of an intravascular stent(s), open or percutaneous, non-coronary, each additional vessel	May be used for adjunct endovascular management of additional lesions or for hybrid procedures.
`36415`	Collection of venous blood by venipuncture	Performed for preoperative labs and crossmatch for potential blood transfusion.
`99100`	Anesthesia for procedures on the upper abdomen, lower abdomen, scrotum and perineum when performed with major truncal procedures	Listed as example of anesthesia-related coding; general anesthesia is typically reported by anesthesia providers separately.