CPT 35583 Femoral-Popliteal Bypass Reimbursement

CPT code 35583 represents an open vascular surgical procedure: a femoral-to-popliteal bypass using the patient’s saphenous vein to bypass femoral artery obstruction and restore lower-extremity perfusion. This code captures a high-acuity revascularization service used in the management of advanced peripheral arterial disease and critical limb ischemia. Nationally, surgical bypass remains an important therapeutic option when endovascular interventions are not feasible or have failed, with implications for hospital resource use, surgical specialty billing, and post-operative care pathways.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing-oriented overview of the procedure represented by this code, an explanation of typical sites of service, and what metrics are commonly evaluated around such procedures (e.g., utilization, setting of care, and related surgical quality considerations). The publication outlines benchmark concepts and policy-relevant context affecting coverage and reimbursement for open vascular bypass procedures, and it summarizes clinical indications and procedural scope to inform billing, coding reviews, and payer-provider discussions.

Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, and detailed payer-specific reimbursement benchmarks.

Billing Code Overview

CPT code 35583 describes a femoral to popliteal bypass using the patient's saphenous vein to bypass an arterial blockage in the femoral artery and restore blood flow to the lower extremity. This procedure is a surgical revascularization service that typically addresses peripheral arterial disease when less invasive endovascular options are unsuitable or have failed.

Service Type: Open vascular surgical bypass

Typical Site of Service: Inpatient or outpatient surgical setting, commonly performed in an operating room with vascular surgery capability

Clinical Context

A 68-year-old male with a history of peripheral arterial disease, tobacco use, hypertension, and hyperlipidemia presents with progressive right lower-extremity claudication and rest pain. Noninvasive vascular studies and arterial duplex demonstrate a significant occlusive lesion of the superficial femoral artery with diminished distal popliteal runoff. After evaluation by vascular surgery, the patient is scheduled for an open femoral-to-popliteal bypass using the ipsilateral great saphenous vein as the conduit to restore inflow to the distal limb and relieve ischemic symptoms. The clinical workflow includes preoperative assessment (cardiac clearance, medication review, duplex/angiographic imaging), intraoperative harvesting of the saphenous vein, creation of the femoro-popliteal bypass graft under general or regional anesthesia, intraoperative assessment of graft flow, and postoperative monitoring in the recovery unit or surgical floor with vascular checks, wound care, anticoagulation management, and follow-up duplex surveillance.

Coding Specifications

Modifier	Description	When to Use
`RT`	Right side	Use when the procedure is performed on the right lower extremity.
`LT`	Left side

Taxonomy Code	Specialty	Notes
`207P00000X`	Vascular Surgery	Primary specialty performing open femoral–popliteal bypass procedures.
`207L00000X`	General Surgery	General surgeons with vascular training who perform peripheral bypass procedures.
`207R00000X`	Thoracic and Cardiovascular Surgery	Vascular reconstructions of peripheral arteries performed by cardiac/vascular surgeons.
`208100000X`	Emergency Medicine	May be involved in acute ischemia evaluation and initial stabilization before surgical transfer.
`207LP2900X`	Vascular Medicine	Nonoperative vascular specialists involved in preoperative assessment and postoperative surveillance.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of extremities with rest pain, bilateral legs	Common indication for femoral-to-popliteal bypass when atherosclerotic occlusive disease causes ischemia.
`I70.214`	Atherosclerosis of native arteries of extremities with rest pain, left leg	Side-specific code when left limb is affected and bypass is indicated.
`I70.215`	Atherosclerosis of native arteries of extremities with rest pain, right leg	Side-specific code when right limb is affected and bypass is indicated.
`I70.231`	Atherosclerosis of native arteries of the extremities with ulceration, bilateral legs	Indicates tissue loss or ulceration prompting revascularization.
`I70.235`	Atherosclerosis of native arteries of the extremities with gangrene, right leg	Severe ischemia with gangrene necessitating revascularization to salvage limb.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`93975`	Duplex scan of lower extremity arteries; arterial mapping, one leg	Preoperative arterial mapping to plan conduit and identify occlusion level.
`36147`	Introduction of catheter with selective catheterization, lower extremity arteries (e.g., for diagnostic angiography)	Diagnostic lower extremity angiography or catheter-based runoff assessment prior to bypass.
`35476`	Insertion of temporary intravascular shunt, upper or lower extremity, arterial	Used intraoperatively when temporary shunting is required to maintain distal perfusion during grafting.
`36821`	Thrombectomy, open, arterial (e.g., for acute graft thrombosis)	Performed if graft thrombosis occurs intraoperatively or postoperatively requiring open thrombectomy.
`99223`	Initial hospital care, typically 70 minutes or more	Preoperative inpatient evaluation/management on the day of major vascular surgery.

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Summary & Overview

CPT 35583: Femoral to Popliteal Bypass Using Saphenous Vein