CPT 35563 Iliac-to-Iliac Vein Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35563: Iliac-to-Iliac Artery Bypass with Vein Graft

CPT code 35563 represents an iliac-to-iliac arterial bypass using a vein graft to bypass an iliac artery obstruction. This major vascular surgery restores distal perfusion to the lower extremity and is performed when endovascular options are insufficient or anatomically unsuitable. Nationally, procedures coded with 35563 are important markers of advanced peripheral arterial disease care and resource use in vascular surgery.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses coverage patterns and reimbursement benchmarks across public and major commercial plans, highlighting how payment and utilization considerations affect hospital and vascular surgery practices.

Readers will find a concise clinical context for the procedure, typical sites of service, and an overview of common modifiers used with the code. The publication also outlines benchmark metrics for frequency and allowed amounts where available, and summarizes any recent policy or coding guidance relevant to vascular bypass procedures. Data gaps are noted where input information is not provided.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35563vascular surgeryiliac artery bypassperipheral arterial diseasevein graftsurgical revascularizationhospital servicesprocedure coding

Billing Code Overview

CPT code 35563 describes a surgical revascularization procedure in which the provider bypasses a blockage in an iliac artery by inserting a bypass graft that connects one iliac artery to the other using a vein graft. This procedure is a form of peripheral arterial bypass intended to restore blood flow to the lower extremity when iliac arterial obstruction is present.

Service type: Surgical arterial bypass/revascularization
Typical site of service: Hospital operating room or other inpatient/outpatient surgical setting where major vascular procedures are performed

Clinical & Coding Specifications

Clinical Context

A typical patient is an older adult with severe aortoiliac occlusive disease presenting with lifestyle-limiting claudication or critical limb ischemia (rest pain, nonhealing ulcers) refractory to medical therapy and endovascular intervention. The vascular surgery team evaluates history, ankle-brachial indices, arterial duplex, CTA or MRA demonstrating iliac artery occlusion or high-grade stenosis. After informed consent and preoperative evaluation, the patient is taken to the operating room for open revascularization. Under general anesthesia and with vascular surgery and anesthesia teams present, the surgeon harvests an autogenous vein conduit (commonly greater saphenous vein), exposes the diseased iliac arteries via an appropriate incision, performs proximal and distal vessel control, and constructs a bypass graft connecting one iliac artery to the contralateral or ipsilateral iliac artery to restore inflow. Intraoperative heparinization, graft tunneling, and completion angiography or duplex may be performed. Postoperative care includes monitoring in a step-down or intensive care setting depending on comorbidity, anticoagulation or antiplatelet therapy management, wound care, and surveillance duplex imaging. Typical site of service: inpatient operating room or ambulatory surgery center when medically appropriate. Service type: open vascular surgical bypass (iliac-to-iliac) using vein graft.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for due to complexity or unexpected conditions.

CPT 35531: Aorto-to-Celiac/Mesenteric Vein Bypass Graft

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

CPT 35510: Carotid-to-Brachial 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-35537-AORTO-ILIAC-BYPASS-VEIN-GRAFT

CPT 35537: Aorto‑iliac Bypass with Vein Graft

CPT-35526-AORTO-SUBCLAVIAN-INNOMINATE-CAROTID-VEIN-BYPASS

CPT 35526: Aorto-Subclavian/Innominate/Carotid Vein Bypass

CPT-35511-SUBCLAVIAN-ARTERY-TO-SUBCLAVIAN-ARTERY-VEIN-BYPASS

CPT 35511: Subclavian-to-Subclavian Vein Bypass Graft

CPT-35539-AORTO-FEMORAL-VEIN-BYPASS-GRAFT

CPT 35539: Aorto-Femoral Vein Bypass Graft

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

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

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

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

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

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

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35563

Taxonomy Code	Specialty	Notes
207P00000X	Vascular Surgery	Primary specialty performing open iliac bypass procedures.
207R00000X	General Surgery	General surgeons with vascular training may perform this operation.
208800000X	Thoracic and Cardiovascular Surgery	Cardiothoracic/vascular surgeons may perform complex pelvic arterial bypass.
207LG0400X	Interventional Radiology	Supports pre- or post-procedure endovascular diagnostics and interventions.
208E00000X	Diagnostic Radiology	Provides intraoperative or preoperative imaging such as angiography.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of the extremities with intermittent claudication, bilateral legs	Common indication when iliac occlusive disease causes lifestyle-limiting claudication necessitating bypass.
`I70.235`	Atherosclerosis of native arteries of the extremities with ulceration, bilateral legs	Indicates tissue loss or ulceration from ischemia prompting revascularization.
`I70.24`	Atherosclerosis of native arteries of the extremities with rest pain, bilateral legs	Rest pain reflects critical limb ischemia often requiring surgical bypass.
`I74.3`	Embolism and thrombosis of artery of lower extremity	Acute or chronic embolic disease may necessitate bypass if primary repair not feasible.
`K55.0`	Acute vascular insufficiency of intestine	(Not directly related)

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35600`	Open treatment of femoral artery aneurysm; with graft	May be performed in the same vascular operative session when concurrent femoral disease requires repair.
`35720`	Femoral-popliteal bypass, with vein graft (above-knee)	Performed when distal bypass is indicated in addition to iliac revascularization to restore limb perfusion.
`35736`	Femoral-popliteal bypass, with synthetic graft (below-knee)	Alternative or adjunctive distal bypass procedure in multilevel peripheral arterial disease.
`36245`	Selective catheter placement, arterial, initial third order or more selective thoracic, abdominal, lower extremity arteries	Used for diagnostic or therapeutic angiography preoperatively or intraoperatively to map lesions.
`75894`	Transcatheter intra-arterial therapy, radiological supervision and interpretation (angiographic)	Used for completion angiography to document graft patency intraoperatively.
`20937`	Reconstruction, clavicle or scapula; with vascularized tissue (not exact match)	Data not directly applicable but included when complex reconstruction with vascularized grafts is necessary.

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