CPT 35538 Aorto-Iliac Vein Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35538: Aorto-Iliac Bypass with Vein Graft

CPT code 35538 represents an open aorto-iliac bypass using a vein graft to route blood from the aorta to both iliac arteries around obstructive disease. This is a major vascular surgical procedure with nationwide clinical and payment significance because it addresses limb- and life-threatening arterial occlusive disease and typically involves inpatient operative care and post-operative monitoring. Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what CPT code 35538 denotes clinically and operationally, the typical site of service and care pathways associated with the procedure, and what to expect from payer coverage perspectives. The publication provides benchmarks where available, summarizes relevant policy and coding considerations, and situates the code within vascular surgery service lines and inpatient care patterns. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35538aorto-iliac bypassvascular surgeryvein graftinpatient surgeryoperative carevascular procedural codingsurgical bypass

Billing Code Overview

CPT code 35538 describes a surgical bypass procedure in which the provider bypasses a blockage in the iliac arteries by inserting a bypass graft that connects the aorta to portions of both iliac arteries using a vein graft. Service type: open vascular bypass surgery. Typical site of service: inpatient hospital operating room or higher-acuity surgical setting where major vascular procedures are performed.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an older adult with progressive aortoiliac occlusive disease causing lifestyle-limiting claudication and/or threatened limb ischemia. The patient often has peripheral arterial disease risk factors such as long-standing smoking history, diabetes mellitus, hypertension, and hyperlipidemia. Symptoms include buttock, thigh, or calf claudication, rest pain, nonhealing foot ulcers, or gangrene. Noninvasive vascular testing (ABI, duplex ultrasound) and cross-sectional imaging (CTA or MRA) demonstrate extensive atherosclerotic occlusive disease at the aortoiliac segment unsuitable for endovascular repair alone.

The clinical workflow includes preoperative assessment with cardiopulmonary risk stratification, medication optimization (antiplatelet and statin therapy), and informed consent. In the operating room under general or regional anesthesia, the vascular surgeon harvests an autogenous vein graft or prepares a prosthetic conduit, performs a midline laparotomy or retroperitoneal exposure, clamps the aorta, and constructs a bifurcated aortobiiliac bypass from the infrarenal aorta to both common or external iliac arteries to reestablish inline flow. Postoperative care involves ICU or step-down monitoring, serial vascular examinations, duplex surveillance, analgesia, venous thromboembolism prophylaxis, and long-term secondary prevention management.

Typical site of service: Inpatient operating room with possible ICU or step-down postoperative admission.

Service type: Open vascular surgical bypass (aortobiiliac bypass via vein graft).

Coding Specifications

Modifier	Description	When to Use

CPT 35521: Axillary-to-Femoral Vein Bypass

CPT-35525-BRACHIAL-ARTERY-BRACHIAL-ARTERY-VEIN-BYPASS-GRAFT

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

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

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

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

CPT 35523: Brachial to Ulnar or Radial Vein Bypass

CPT-35510-CAROTID-TO-BRACHIAL-ARTERY-BYPASS-VEIN-GRAFT

CPT 35510: Carotid-to-Brachial Artery Bypass with Vein Graft

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

CPT 35531: Aorto-to-Celiac/Mesenteric Vein 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-35508-CAROTID-TO-VERTEBRAL-BYPASS-GRAFT

CPT 35508: Carotid-to-Vertebral Artery Bypass Graft

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

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

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Taxonomy Code	Specialty	Notes
2080S0400X	Vascular Surgery	Primary specialty performing open aortobiiliac bypass procedures
207L00000X	General Surgery	General surgeons with vascular training may perform complex aortic/iliac bypass
207RH0000X	Thoracic and Cardiac Surgery	Relevant when aortic exposure or concurrent cardiac procedures are present
2084P0800X	Interventional Radiology	Involved preoperatively for imaging and possible hybrid endovascular adjuncts
363L00000X	Podiatry (Surgery)	May be involved in pre/postoperative limb salvage and wound care

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.211`	Atherosclerosis of native arteries of extremities with rest pain, right leg	Common manifestation of severe aortoiliac occlusive disease prompting revascularization
`I70.212`	Atherosclerosis of native arteries of extremities with rest pain, left leg	As above for left-sided symptoms or bilateral disease
`I70.21`	Atherosclerosis of native arteries of extremities with intermittent claudication	Typical indication for consideration of bypass when lifestyle-limiting claudication and anatomy unfavorable for endovascular therapy
`I70.23`	Atherosclerosis of native arteries of extremities with ulceration	Tissue loss or nonhealing ulcers often necessitate revascularization such as aortobiiliac bypass
`I70.24`	Atherosclerosis of native arteries of extremities with gangrene	Advanced limb-threatening ischemia where aortic to iliac bypass can salvage the limb
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Embolic or thrombotic occlusion may require bypass if endovascular options are inadequate
`I71.3`	Abdominal aortic aneurysm, ruptured or without rupture (if involving occlusive disease)	Concomitant aortic pathology may alter operative planning for aortoiliac bypass
`R02`	Gangrene, not elsewhere classified	Clinical descriptor that correlates with limb-threatening ischemia requiring revascularization

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35666`	Embolectomy, profunda femoris, with or without exploration of femoral artery	Performed when concurrent distal embolectomy is required during revascularization for embolic complications
`35831`	Endarterectomy, iliac artery, with patch graft, unilateral	Alternative or adjunct open procedure for focal iliac disease; may be performed in staged or hybrid approaches
`35556`	Bypass graft, with other than autogenous vein, thoracoabdominal aorta to iliac, each graft	Related aortoiliac/proximal bypass codes for different conduit types and extents; useful for coding alternative graft configurations
`36147`	Insertion of intra-arterial catheter, infusion for thrombolysis	Used preoperatively or postoperatively in hybrid cases for catheter-directed thrombolysis of thrombus before or after open bypass
`93925`	Duplex scan of arterial bypass grafts, surveillance or postoperative evaluation	Commonly performed postoperatively for graft surveillance and to document patency

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