CPT 35539 Aorto-Femoral Vein Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35539: Aorto-Femoral Vein Bypass Graft

CPT code 35539 represents an open vascular surgical procedure in which a vein graft is used to create a bypass from the aorta to the femoral artery to circumvent an arterial occlusion. This high-acuity operative service is clinically important for limb salvage and treating advanced peripheral arterial disease. Nationally, the code is relevant to hospitals, vascular surgery practices, and payers managing complex vascular care.

Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for CPT code 35539, typical sites of service, and the service type. The publication also summarizes payer coverage patterns, allowed charge benchmarks where available, and common billing considerations tied to open aorto-femoral bypass procedures.

This resource provides clinicians, billing professionals, and policy analysts with concise guidance on the clinical intent of CPT code 35539, expected care settings, and the topics covered in the full report, including reimbursement benchmarks, coding nuances, and policy updates affecting vascular surgical services. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35539aorto-femoral bypassvascular surgeryvein graftperipheral arterial diseaseinpatient surgeryoperative proceduresurgical billing

Billing Code Overview

CPT code 35539 describes a surgical arterial bypass in which the provider creates a bypass graft from the aorta to a segment of the femoral artery using a vein graft. This procedure is performed to bypass an occlusive lesion in a major lower-extremity artery and restore blood flow to the limb.

Service type: Open vascular surgical bypass grafting
Typical site of service: Hospital operating room or inpatient surgical setting

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old male with progressive right lower-extremity rest pain, nonhealing ischemic ulceration of the forefoot, and decreased ankle-brachial index following a history of peripheral arterial disease and long-segment aortoiliac and femoral occlusive disease. Vascular surgery evaluation including arterial duplex and CT angiography documents an occlusive lesion of the common femoral or profunda femoris inflow that is not amenable to endovascular-only repair. The treatment plan is an open surgical revascularization in the operating room under general anesthesia. The surgeon harvests an autogenous greater saphenous vein, constructs a proximal anastomosis to the infrarenal abdominal aorta, and tunnels the vein graft to the common or superficial femoral artery to bypass the diseased segment, consistent with an aorto–femoral (aorto–common femoral or aorto–femoral) bypass using a vein conduit. Typical perioperative workflow includes preoperative cardiopulmonary assessment, intraoperative heparinization and graft assessment (duplex or completion angiography as indicated), postoperative intensive monitoring for limb perfusion, wound care, and antiplatelet therapy.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (neutral)	Use when no specific modifier applies; standard reporting.

CPT 35500: Upper-Extremity Vein Harvest for Bypass Conduit

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

CPT 35522: Axillary-to-Brachial Vein Bypass

CPT-35533-AXILLOFEMORAL-BYPASS-VEIN-GRAFT-BILATERAL

CPT 35533: Axillofemoral Bypass Using Vein Graft, Bilateral

CPT-35558-FEMORAL-FEMORAL-VEIN-BYPASS

CPT 35558: Femoral–Femoral Bypass with Vein Graft

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

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

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

CPT 35523: Brachial to Ulnar or Radial Vein Bypass

CPT-35538-AORTO-ILIAC-VEIN-BYPASS

CPT 35538: Aorto-Iliac Bypass with Vein Graft

CPT-35508-CAROTID-TO-VERTEBRAL-BYPASS-GRAFT

CPT 35508: Carotid-to-Vertebral Artery Bypass Graft

CPT-35565-ILIAC-TO-FEMORAL-VEIN-BYPASS

CPT 35565: Iliac-to-Femoral Vein Graft Bypass

CPT-35540-AORTO-BIFEMORAL-VEIN-BYPASS-GRAFT

CPT 35540: Aorto‑bifemoral Vein Bypass Graft

Showing 1–10 of 32

11

Taxonomy Code	Specialty	Notes
207L00000X	Vascular Surgery	Primary specialty performing lower extremity bypass procedures.
2080P0207X	General Surgery	General surgeons with vascular training perform aorto-femoral bypass in some centers.
207K00000X	Cardiothoracic Surgery	In centers where aortic exposure or conduit work involves cardiothoracic expertise.
2084P0800X	Interventional Radiology	Provides preoperative endovascular adjuncts, imaging, or completion angiography support.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.2`	Atherosclerosis of native arteries of the extremities	Primary cause of peripheral arterial occlusive disease requiring bypass.
`I70.219`	Atherosclerosis of native arteries of the extremities, bilateral legs, with intermittent claudication	Represents symptomatic limb ischemia leading to revascularization.
`I70.23`	Atherosclerosis of native arteries of the extremities with ulceration	Indicates tissue loss or ulceration prompting limb-salvage bypass.
`I70.21`	Atherosclerosis of native arteries of the extremities with intermittent claudication, right leg	Used when laterality and claudication symptoms are documented.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute on chronic presentation that may require bypass if endovascular therapy fails.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35539`	Aorto-femoral bypass, with vein graft (aorta to femoral)	Primary procedure: bypass of aortoiliac/femoral occlusion with autogenous vein graft.
`35820`	Revision, repair of vascular graft; aorto-iliac or aorto-femoral	Performed when graft complications require revision or repair after initial bypass.
`36245`	Selective catheter placement, aorta, abdominal, with angiography	Often performed preoperatively or intraoperatively for diagnostic angiography or completion study.
`93975`	Duplex scan of extremity arteries, postoperative surveillance study	Used for noninvasive graft surveillance during postoperative follow-up.
`34701`	Tissue or vessel graft replacement, arterial; allograft/autograft (typical code for femoral artery conduit work)	May be reported for accompanying arterial conduit work or complex arterial reconstruction when applicable.

OpenPayer