35556 Femoral–Popliteal Vein Bypass CPT Reimbursement | OpenPayer

Summary & Overview

CPT 35556: Femoral to Popliteal Vein Bypass Graft

CPT code 35556 represents an open lower-extremity vascular bypass in which a vein graft connects the femoral artery to a portion of the popliteal artery to circumvent an obstructed arterial segment. This procedure is essential for limb-salvage and management of critical limb ischemia and significant peripheral arterial disease when endovascular options are infeasible. Nationally, such bypass procedures remain a key component of vascular surgery practice and influence hospital surgical workloads, resource utilization, and perioperative care pathways.

Key payers commonly covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview, typical sites of service, and the primary considerations relevant to coverage and claims processing. The publication provides benchmarks for utilization patterns, common payer coverage contexts, and a clinical context for when CPT code 35556 is employed. Data not available in the input is noted where applicable. The content is intended for health plan analysts, coding professionals, and hospital billing teams seeking a clear national-level summary of CPT code 35556 and its role in vascular surgical services.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35556CPTvascular-surgerybypass-graftfemoral-poplitealperipheral-arterial-diseaselimb-salvageinpatient-surgery

Billing Code Overview

CPT code 35556 describes a surgical bypass procedure in which the provider bypasses an occluded segment of a lower-extremity artery by inserting a bypass graft that connects the femoral artery to a portion of the popliteal artery using a vein graft. This procedure restores arterial blood flow to the lower leg and foot when native arterial segments are blocked or unsuitable for direct repair.

Service type: Open vascular bypass surgery of the lower extremity
Typical site of service: Inpatient hospital operating room or specialized vascular surgery suite for major vascular reconstruction

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with long-standing peripheral arterial disease presents with progressive right lower-extremity rest pain and non-healing ulceration of the lateral ankle. Noninvasive arterial Doppler studies and lower-extremity angiography demonstrate an occlusive lesion of the superficial femoral artery with inadequate runoff to the distal popliteal segment. The vascular surgery team schedules an open femoral–popliteal bypass using an autogenous vein graft.

The clinical workflow includes preoperative vascular assessment (ankle-brachial index, duplex ultrasound, CTA or diagnostic angiography), medical optimization (antiplatelet therapy, statin, smoking cessation counseling), informed consent discussing risks (bleeding, infection, graft occlusion), operative procedure (harvest of ipsilateral or contralateral greater saphenous vein, proximal femoral arteriotomy, tunneling of vein graft, distal popliteal anastomosis), immediate postoperative monitoring in PACU or step-down unit, duplex graft surveillance before discharge, and scheduled follow-up for wound care and surveillance imaging. Typical site of service is an operating room in a hospital or an ambulatory surgical center for lower-extremity bypass when inpatient admission is not required.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When reporting the surgeon's professional service separate from technical facility charges (rare for operative procedures billed by the surgeon).

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

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

CPT 35522: Axillary-to-Brachial Vein Bypass

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

CPT 35572: Femoropopliteal Vein Harvest for Vascular Reconstruction

CPT-35537-AORTO-ILIAC-BYPASS-VEIN-GRAFT

CPT 35537: Aorto‑iliac Bypass with Vein Graft

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

CPT 35500: Upper-Extremity Vein Harvest for Bypass Conduit

CPT-35538-AORTO-ILIAC-VEIN-BYPASS

CPT 35538: Aorto-Iliac Bypass with Vein Graft

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

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

CPT-35515-SUBCLAVIAN-TO-VERTEBRAL-ARTERY-BYPASS-VEIN-GRAFT

CPT 35515: Subclavian-to-Vertebral Artery Bypass with Vein Graft

CPT-35558-FEMORAL-FEMORAL-VEIN-BYPASS

CPT 35558: Femoral–Femoral Bypass with Vein Graft

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

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

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Taxonomy Code	Specialty	Notes
207P00000X	Vascular Surgery	Primary specialty performing femoral–popliteal bypass procedures.
208000000X	General Surgery	Often performs peripheral bypass procedures in some centers.
2080P0207X	Thoracic and Cardiovascular Surgery	May perform peripheral vascular bypass in complex patients.
221K00000X	Interventional Cardiology	Involved in endovascular alternatives; less commonly performs open bypass.
352500000X	Physician Assistant	Surgical assistant or proceduralist under supervision as allowed by state law.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of the extremities with rest pain, right leg	Common indication for femoral–popliteal bypass when severe limb ischemia with rest pain is present.
`I70.214`	Atherosclerosis of native arteries of the extremities with rest pain, left leg	Same clinical relevance for left-sided disease.
`I70.233`	Atherosclerosis of native arteries of the extremities with ulceration, right leg	Indicates tissue loss/ulceration prompting revascularization to salvage limb.
`I70.234`	Atherosclerosis of native arteries of the extremities with ulceration, left leg	As above for left-sided disease.
`I70.235`	Atherosclerosis of native arteries of the extremities with gangrene, right leg	Severe ischemia with tissue necrosis often requiring urgent revascularization.
`I70.236`	Atherosclerosis of native arteries of the extremities with gangrene, left leg	As above for left-sided gangrene.
`I73.9`	Peripheral vascular disease, unspecified	General diagnosis commonly associated with indications for bypass when more specific codes are not documented.
`E11.51`	Type 2 diabetes mellitus with peripheral angiopathy without gangrene	Diabetes is a major risk factor for peripheral arterial disease and influences surgical planning and wound healing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35556`	Femoral to popliteal bypass with vein graft (as described)	Primary operative code for the open bypass connecting femoral to popliteal artery with autogenous vein graft.
`36147`	Introduction of peripheral catheter for diagnostic angiography, lower extremity, percutaneous	Diagnostic angiography codes may be used preoperatively for angiographic mapping if performed separately.
`37224`	Revascularization, endovascular, open or percutaneous, femoropopliteal artery, with stent(s)	Endovascular alternative or adjunct performed before or after bypass in hybrid procedures.
`35341`	Anastomosis, direct, arterial, open; femoral to popliteal (single segment)	Related open arterial anastomosis codes that describe operative segments; used when coding variations or component reporting are required.
`93925`	Duplex scan of arterial inflow and outflow of lower extremity with spectral and color flow	Pre- and postoperative noninvasive surveillance commonly performed to assess graft patency.
`99223`	Initial hospital care, typically 70 minutes or more, high complexity (example inpatient preop/postop)	Inpatient evaluation and management services for a patient admitted for the bypass procedure.

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