CPT 35565 Iliac-to-Femoral Vein Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35565: Iliac-to-Femoral Vein Graft Bypass

CPT code 35565 represents an open peripheral arterial bypass procedure connecting the iliac artery to the femoral artery using a vein graft. This revascularization surgery is performed to bypass occlusive disease in the iliac-femoral segment and restore lower-extremity blood flow. The procedure has significance nationally due to its role in limb salvage, reducing ischemic symptoms, and its implications for hospital resource use and surgical quality measures.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and typical care settings, plus benchmark-oriented content distinguishing payer coverage patterns, reimbursement considerations, and quality reporting implications where available. The publication also summarizes relevant procedural context for coding and billing teams, including common service lines and sites of care.

This report is organized to give clinicians, coding professionals, and policy analysts a clear, practical reference: what the code denotes, why it matters for patient care and system costs, and what to expect in payer interactions and hospital workflows. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35565CPTperipheral-arterial-bypassvascular-surgeryiliac-to-femoral-bypassvein-graftsurgical-procedurehospital-surgery

Billing Code Overview

CPT code 35565 describes a surgical bypass procedure in which the provider bypasses an arterial blockage by inserting a bypass graft that connects the iliac artery to a portion of the femoral artery using a vein graft.

Service type: Open peripheral arterial bypass surgery
Typical site of service: Hospital operating room or inpatient surgical suite

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old with progressive left lower-extremity claudication and an ankle-brachial index of 0.5, with imaging (CT angiography or duplex ultrasound) showing high-grade occlusive disease of the common or external iliac artery and disease extending to the common femoral or profunda femoris origin. After failed or unsuitable endovascular therapy or when multilevel disease favors surgical repair, the vascular surgeon performs an extra-anatomic or anatomic bypass using autogenous vein. The procedure involves harvesting the greater saphenous vein (or using another conduit), heparinization, proximal anastomosis to the iliac artery, tunneling the graft, and distal anastomosis to the femoral artery segment to restore inflow.

Perioperative workflow includes preoperative cardiac and vascular risk assessment, consent with discussion of limb-salvage goals and graft options, intraoperative monitoring (arterial line, central access as indicated), prophylactic antibiotics, and postoperative limb perfusion monitoring with serial vascular exams and duplex imaging. Typical site of service is an inpatient operating room in a hospital or an accredited ambulatory surgery center for select low-risk patients. The service type is major vascular surgical bypass (open surgical revascularization).

Coding Specifications

Modifier	Description	When to Use
`00`	Default — No modifier	Use when no specific modifier applies to the service.

CPT 35521: Axillary-to-Femoral Vein Bypass

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

CPT 35533: Axillofemoral Bypass Using Vein Graft, Bilateral

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

CPT 35572: Femoropopliteal Vein Harvest for Vascular Reconstruction

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

CPT 35540: Aorto‑bifemoral Vein Bypass Graft

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

CPT 35571: Popliteal to Tibial/Peroneal Arterial Bypass

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

CPT 35537: Aorto‑iliac Bypass with Vein Graft

CPT-35570-TIBIAL-PERONEAL-ARTERY-BYPASS

CPT 35570: Tibial and Peroneal Artery Bypass Procedures

CPT-35560-RENAL-ARTERY-BYPASS-VEIN-GRAFT

CPT 35560: Aorta-to-Renal Artery Bypass Using Vein Graft

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

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

CPT-35531-AORTO-VISCERAL-VEIN-BYPASS-GRAFT

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

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Taxonomy Code	Specialty	Notes
207RP1000X	Vascular Surgery	Primary specialty performing lower-extremity arterial bypass procedures.
2080P0202X	General Surgery	Many vascular bypasses are performed by general surgeons with vascular focus.
2080S0123X	Cardiothoracic & Vascular Surgery	Surgeons with combined expertise in thoracic and peripheral vascular procedures.
363A00000X	Physician Assistant	Common ancillary provider assisting intraoperatively and in perioperative management.
207Q00000X	Registered Nurse Practitioner	Involved in preoperative and postoperative vascular care and follow-up.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of extremities with rest pain, right leg	Peripheral arterial disease causing ischemic symptoms that may require iliac-femoral bypass.
`I70.214`	Atherosclerosis of native arteries of extremities with rest pain, left leg	Same clinical relevance for left-sided disease.
`I70.221`	Atherosclerosis of native arteries of extremities with intermittent claudication, right leg	Typical indication when lifestyle-limiting claudication persists despite conservative therapy.
`I70.222`	Atherosclerosis of native arteries of extremities with intermittent claudication, left leg	Indication for revascularization to improve ambulation and quality of life.
`I70.231`	Atherosclerosis of native arteries of extremities with ulceration, right leg	Tissue loss/ulceration may necessitate revascularization for limb salvage.
`I70.232`	Atherosclerosis of native arteries of extremities with ulceration, left leg	Same as above for left-sided ulcers.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute embolic or thrombotic occlusion that might be treated with bypass if thromboembolectomy or endovascular therapy is not feasible.
`I96`	Gangrene, not elsewhere classified	Advanced ischemia with tissue necrosis often requires urgent revascularization for limb salvage.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35566`	Bypass, iliac to femoral, with synthetic graft (eg, Dacron)	Alternative conduit option; selected when autogenous vein is unsuitable or unavailable.
`35666`	Bypass graft, femoral to popliteal, with vein; single segment	May be performed in the same patient for multilevel revascularization distal to the femoral anastomosis.
`35866`	Thrombectomy, arterial, with graft salvage	Performed if an acute graft thrombosis occurs intraoperatively or postoperatively requiring thrombus removal.
`36901`	Endovascular revascularization, tibial/peroneal; transluminal angioplasty, initial vessel	May be combined staged or adjunctive to open bypass in multilevel disease as a hybrid approach.
`36147`	Introduction of needle and/or catheter into femoral artery for diagnostic or therapeutic purposes (arterial catheterization)	Used for intraoperative or preoperative angiography and access management during hybrid procedures.
`20937`	Harvesting of saphenous vein, other than for coronary bypass	Often performed to obtain autogenous conduit for the bypass graft.

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