CPT 35566 Femoral-to-Tibial Bypass Reimbursement | OpenPayer

Summary & Overview

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

CPT code 35566 represents a peripheral arterial bypass procedure that connects the femoral artery to a distal tibial or peroneal artery using a graft or the patient’s own vein. It is a critical revascularization surgery for patients with significant femoral artery occlusive disease or traumatic arterial injury and carries substantial implications for limb salvage, perioperative resource use, and bundled payment arrangements. Nationally, this code is relevant to hospital systems, vascular surgery practices, and payers managing high-cost vascular care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for 35566, typical sites of service, and the common modifiers associated with vascular surgical billing. The publication presents benchmarking information where available, summarizes policy and coverage considerations that commonly affect authorization and reimbursement, and outlines coding relationships relevant for claims submission and revenue-cycle workflows. Data not available in the input will be identified as such in the detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35566peripheral arterial bypassvascular surgerylower extremity revascularizationsurgical billinghospital serviceslimb salvage

Billing Code Overview

CPT code 35566 describes a surgical arterial bypass in which the surgeon creates a femoral-to-anterior tibial artery, femoral-to-posterior tibial artery, or femoral-to-peroneal artery bypass using a graft or an autologous vein harvested from the patient. This procedure is performed to bypass a damaged or obstructed segment of the femoral artery and restore distal lower-extremity blood flow.

Service type: Peripheral arterial bypass surgery
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 68-year-old male with long-standing type 2 diabetes mellitus, hypertension, hyperlipidemia, and a 40-pack-year smoking history presents with rest pain of the right lower extremity and nonhealing ischemic ulcer on the dorsum of the foot. Noninvasive vascular studies and diagnostic angiography demonstrate an occlusive lesion of the superficial femoral artery with inadequate distal runoff to the pedal arteries, and the anterior tibial artery is suitable as a target. The vascular surgery team elects to perform a femoral-to-anterior tibial bypass using a reversed autologous saphenous vein graft harvested from the ipsilateral thigh.

The clinical workflow includes preoperative evaluation (cardiac risk assessment, imaging with arterial duplex and/or CT angiography), intraoperative vein harvest and bypass construction under general or regional anesthesia, intraoperative duplex or angiographic confirmation of graft patency, and postoperative monitoring in a surgical unit with anticoagulation or antiplatelet therapy and wound care. Typical documentation includes operative note with conduit type, anastomosis sites (common or superficial femoral artery to anterior tibial artery), graft length, use of intraoperative imaging, laterality, and any complications such as bleeding or nerve injury.

Coding Specifications

Modifier	Description	When to Use
`50`	Bilateral procedure	When identical bypass procedures are performed on both lower extremities in the same operative session

CPT 35501: Carotid Common-to-Internal Artery Bypass Graft

CPT-35516-SUBCLAVIAN-TO-AXILLARY-VEIN-BYPASS

CPT 35516: Subclavian-to-Axillary Vein Bypass

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

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

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

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

CPT-35538-AORTO-ILIAC-VEIN-BYPASS

CPT 35538: Aorto-Iliac Bypass with Vein Graft

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

CPT 35522: Axillary-to-Brachial Vein Bypass

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

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

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

CPT 35511: Subclavian-to-Subclavian Vein Bypass Graft

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Taxonomy Code	Specialty	Notes
207H00000X	Vascular Surgery	Primary specialty performing lower extremity bypass procedures
207L00000X	Thoracic and Cardiac Surgery	Surgeons with advanced vascular grafting expertise may perform peripheral bypass in some centers
208000000X	General Surgery	General surgeons with vascular training in community settings may perform peripheral bypass
204SP0800X	Interventional Cardiology	May participate in diagnostic angiography and endovascular adjuncts to bypass procedures
207K00000X	Surgery - Cardiovascular	Surgeons focused on cardiovascular procedures who also perform peripheral bypasses

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of extremities with intermittent claudication, right leg	Common indication for infrainguinal bypass when lifestyle-limiting claudication or progression despite medical therapy
`I70.233`	Atherosclerosis of native arteries of extremities with ulceration, right leg	Indicates tissue loss/ulceration due to peripheral arterial disease necessitating revascularization
`I70.241`	Atherosclerosis of native arteries of extremities with rest pain, right leg	Rest pain signals critical limb ischemia and is an indication for bypass to relieve ischemia
`I70.263`	Atherosclerosis of bypass graft of the leg with intermittent claudication	Pertains to graft failure or disease requiring revision or evaluation in the context of prior bypass procedures
`I96`	Gangrene, not elsewhere classified	Advanced ischemic tissue loss that may prompt revascularization to salvage limb
`E11.51`	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	Diabetes is a major risk factor for peripheral arterial disease and influences outcomes and wound healing
`I73.9`	Peripheral vascular disease, unspecified	General diagnosis code often used pending further specification on imaging or clinical course

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99223`	Initial hospital care, typically 70 minutes or more	Preoperative evaluation for a complex vascular surgery inpatient admission
`36818`	Insertion of intraluminal stent(s), peripheral arterial system; percutaneous, femoral, popliteal, tibial arteries	Endovascular treatment that may be performed before or instead of bypass; may be used on diagnostic angiography-only cases
`35666`	Ligation, avulsion, or other treatment of varicose veins (note: not directly related)	Data not available in the input.
`93925`	Duplex scan of extremity veins with arterial exam	Noninvasive arterial duplex used in preoperative and postoperative assessment
`37196`	Endovascular repair, lower extremity peripheral artery; transluminal balloon angioplasty, percutaneous	May be used as adjunct or alternative to surgical bypass in hybrid procedures

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