CPT 35540 Aorto‑bifemoral Vein Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35540: Aorto‑bifemoral Vein Bypass Graft

CPT code 35540 represents an open aorto-bifemoral bypass using a vein graft to connect the aorta to both femoral arteries and bypass occlusive disease. This major vascular surgery is performed to reestablish perfusion to the lower extremities when native arterial flow is compromised. Nationally, procedures coded with 35540 are significant drivers of vascular surgical resource use and hospital surgical throughput due to operative complexity and typical inpatient recovery.

Key payers covered in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical site-of-service expectations, and notes on common payer considerations. The publication summarizes typical modifiers and common administrative elements associated with billing 35540, highlights where data was not available in the input, and outlines what benchmarks and policy updates would be relevant for stakeholders managing vascular surgical care and reimbursement.

The content is intended to inform hospital coding teams, vascular surgery departments, and payer policy analysts about the clinical nature of the service associated with 35540, operational settings where it is commonly delivered, and the types of materials to consult for claims adjudication and policy alignment.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35540vascular surgeryaorto-bifemoral bypassrevascularizationinpatient surgeryvein graftsurgical codinghospital billing

Billing Code Overview

CPT code 35540 describes a surgical arterial bypass in which the provider bypasses a blockage by inserting a bypass graft that connects the aorta to portions of both femoral arteries using a vein graft. This is a vascular surgical revascularization procedure intended to restore lower-extremity blood flow around significant aortoiliac or femoral arterial obstruction.

Service type: Open vascular bypass surgery

Typical site of service: Inpatient hospital operating room

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old male with long-standing peripheral arterial disease and lifestyle-limiting claudication progressing to rest pain and nonhealing distal foot ulceration. Noninvasive testing (ankle-brachial index, arterial duplex) and angiography identify aortoiliac and femoral arterial occlusive disease unsuitable for endovascular repair. The vascular surgery team schedules an open aortofemoral bypass using an autologous saphenous vein graft that connects the aorta to both femoral arteries.

Preoperative workflow includes cardiovascular risk assessment, medication optimization (antiplatelet and statin therapy), and informed consent documenting risks (bleeding, graft occlusion, infection). Intraoperative workflow involves general anesthesia, midline laparotomy or retroperitoneal exposure of the aorta, harvest and preparation of the vein graft, proximal aortic anastomosis, tunneling of the graft limbs to bilateral femoral arteries, and sequential distal anastomoses. Postoperative workflow includes intensive monitoring, graft patency assessment (Doppler), wound care, anticoagulation management as indicated, and discharge planning with follow-up imaging and wound/vascular clinic visits.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal or routine service	Use when the procedure is the primary, uncomplicated service performed by the reporting surgeon.

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

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-35535-HEPATIC-TO-RENAL-ARTERY-BYPASS-VEIN-GRAFT

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

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

CPT 35533: Axillofemoral Bypass Using Vein Graft, Bilateral

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

CPT 35571: Popliteal to Tibial/Peroneal Arterial Bypass

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

CPT 35565: Iliac-to-Femoral Vein Graft Bypass

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

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

CPT-35500-ARM-VEIN-HARVEST-FOR-BYPASS-CONDUIT

CPT 35500: Upper-Extremity Vein Harvest for Bypass Conduit

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

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

Showing 1–10 of 32

Taxonomy Code	Specialty	Notes
2080S00000X	Vascular Surgery	Primary specialty performing aortofemoral bypass procedures.
207RC0000X	General Surgery	General surgeons with vascular training may perform open bypass procedures.
207RP1001X	Thoracic and Cardiac Surgery	May be involved for complex aortic exposure or combined aortic procedures.
363A00000X	Interventional Cardiology	Rarely involved; typically manages endovascular alternatives rather than open aortofemoral bypass.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of extremities, bilateral legs, with intermittent claudication	Common indication for aorto-bifemoral bypass when aortoiliac/femoral occlusive disease causes claudication refractory to medical/endovascular therapy.
`I70.235`	Atherosclerosis of native arteries of extremities, bilateral legs, with rest pain	Indicates critical limb ischemia with rest pain often prompting open bypass for limb salvage.
`I70.241`	Atherosclerosis of native arteries of extremities, right leg with ulceration	Presence of nonhealing ulceration distal to occlusive disease is an indication for revascularization via bypass.
`I70.242`	Atherosclerosis of native arteries of extremities, left leg with ulceration	As above, guides need for revascularization to achieve wound healing.
`I70.29`	Atherosclerosis of native arteries of extremities, bilateral legs, other manifestations	Covers other ischemic presentations that may prompt bypass.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35566`	Thrombectomy, open, for treatment of acute arterial thrombosis; with or without embolectomy and/or bypass	Performed if intraoperative or early postoperative thrombosis is encountered requiring thrombectomy in conjunction with bypass.
`35831`	Repair, blood vessel, open; with prosthetic graft, aorto-femoral or aorto-iliac bypass	Alternative bypass technique when prosthetic graft is used instead of vein; may be chosen based on conduit availability.
`36818`	Endarterectomy, femoral artery, including patch graft when performed; with or without distal bypass	May be performed concurrently or as an adjunctive procedure on femoral targets during bypass surgery.
`99100`	Anesthesia for procedures on the lower extremity, perineum, and external genitalia	Represents anesthesia services typically used during open aortofemoral bypass (use per payer and anesthesia coding rules).
`93925`	Duplex scan of lower extremity arteries, surveillance post-op, unilateral or bilateral	Used for postoperative graft surveillance to assess patency during inpatient stay or follow-up visits.

OpenPayer