CPT 35558 Femoral–Femoral Vein Bypass Reimbursement

CPT code 35558 designates an open vascular bypass procedure that uses a vein graft to bypass an occlusion in the femoral artery, restoring blood flow to the lower extremity. Nationally, procedures coded with 35558 are clinically important for management of peripheral arterial disease and critical limb ischemia, with implications for surgical quality, postoperative outcomes, and hospital resource use.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, benchmarks and utilization patterns where available, and relevant policy and billing considerations that affect coverage and site-of-service classification. The content summarizes typical settings for the service, expected clinical indications, and operational factors that influence claims processing.

The publication highlights what clinicians, coding professionals, and payers need to recognize about coding and service expectations for femoral–femoral bypass with vein grafting, and outlines areas where policy updates or payer edits commonly affect reimbursement and prior authorization practice. Data not available in the input is noted where applicable.

Billing Code Overview

CPT code 35558 describes a surgical bypass procedure in which the provider bypasses a blockage in the femoral artery by inserting a bypass graft that connects one segment of the femoral artery to another using a vein graft. This procedure is a femoral–femoral bypass using a vein graft and is performed to restore arterial blood flow to the lower extremity when native arterial segments are obstructed.

Service type: Open vascular bypass surgery

Typical site of service: Inpatient hospital operating room

Clinical Context

A typical patient is a 65-year-old man with progressive, lifestyle-limiting left lower extremity claudication and a prior history of peripheral artery disease and tobacco use. Noninvasive testing (ABI with segmental pressures and duplex ultrasound) demonstrates an occlusive lesion of the common femoral or proximal superficial femoral artery with poor inline flow to the distal limb. The vascular surgery team evaluates the patient, reviews imaging (CT angiography or diagnostic peripheral angiography), and determines that an open femoral–femoral or femoral–below-knee bypass using an autogenous vein graft is indicated to restore perfusion.

The clinical workflow includes preoperative assessment (cardiac risk stratification, medication management including antiplatelet/anticoagulation planning), informed consent describing risks and benefits of bypass grafting, intraoperative vein harvest (usually greater saphenous vein) and tunneling of the graft from the femoral artery to the target femoral segment, completion intraoperative duplex or angiography to confirm graft patency, and postoperative monitoring in a PACU or step-down unit. Typical sites of service are inpatient operating room or ambulatory surgical center when appropriate, with postoperative follow-up in the vascular surgery clinic and ankle-brachial index or duplex surveillance to assess graft function.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when only the physician interpretation component is billed (rare for open bypass but applies if imaging interpretation is separately billed).

Taxonomy Code	Specialty	Notes
`207K00000X`	Vascular Surgery	Surgeons who commonly perform open lower extremity bypass procedures.
`208200000X`	General Surgery	General surgeons with vascular training may perform lower extremity bypass.
`2086S0205X`	Cardiothoracic-Vascular Surgery	Surgeons trained in vascular procedures including complex bypass grafts.
`207L00000X`	Plastic and Reconstructive Surgery	Occasionally involved for complex wound management or conduit harvest in limb salvage scenarios.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.219`	Atherosclerosis of native arteries of extremities, unspecified extremity, with intermittent claudication	Common indication for femoral-to-femoral or femoral bypass when lifestyle-limiting claudication is present.
`I70.231`	Atherosclerosis of native arteries of right leg with rest pain	Represents critical limb ischemia requiring revascularization.
`I70.232`	Atherosclerosis of native arteries of left leg with rest pain	Same as above for left lower extremity; guides laterality modifiers like `LT`.
`I70.241`	Atherosclerosis of native arteries of right leg with ulceration	Indicates tissue loss that may necessitate surgical bypass for limb salvage.
`I70.242`	Atherosclerosis of native arteries of left leg with ulceration	Left-sided tissue loss; clinically relevant for operative planning and coding.
`I70.21`	Atherosclerosis of native arteries of extremities with intermittent claudication	General code for symptomatic peripheral artery disease leading to bypass consideration.
`I96`	Gangrene, not elsewhere classified	Severe ischemia complication that may prompt urgent revascularization to attempt limb salvage.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36831`	Revision, thrombectomy and/or embolectomy, artery; open, with graft repair or bypass	May be performed when acute graft thrombosis requires surgical revision during the same hospitalization.
`35301`	Thromboendarterectomy, femoral artery	Often performed for focal femoral lesions and may be an alternative or adjunct to fem-fem bypass in the same vascular territory.
`35476`	Bypass graft, femoral-popliteal (fem-pop), single segment autologous venous graft	Related peripheral bypass procedure; used when the distal target is popliteal rather than femoral.
`76010`	Percutaneous transluminal revascularization, radiological supervision and interpretation; arterial, lower extremity, initial vessel	Diagnostic or adjunct endovascular procedures and imaging commonly performed before or after open bypass to evaluate inflow or outflow.
`93925`	Duplex scan of arterial inflow and outflow, complete bilateral study	Noninvasive vascular laboratory testing used preoperatively and for postoperative surveillance of bypass graft patency.

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Summary & Overview

CPT 35558: Femoral–Femoral Bypass with Vein Graft