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    v1.0.30
    OpenPayerBilling CodesIn-Situ Vein Bypass Graft ProceduresCPT cpt-35585-femoral-to-tibial-peroneal-bypass-saphenous-vein
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    CPT 35585: Femoral-to-Tibial/Peroneal Bypass Using Saphenous Vein

    Medicare pays $1506 on average nationally for this procedure.

    CPT code 35585 describes a surgical arterial bypass procedure using the patient’s saphenous vein to create a femoral-to-anterior tibial, femoral-to-posterior tibial, or femoral-to-peroneal artery bypass to restore lower extremity blood flow; this is a vascular surgery service typically performed in an inpatient or outpatient hospital operating room or an ambulatory surgical center to treat peripheral arterial occlusive disease and salvage limb perfusion.

    For related coverage guidance, see recent payer policy updates: Subtalar Joint Implantation (Subtalar Arthroereisis), Surgery of the Foot (for Idaho Only), Surgery of the Foot (for North Carolina Only).

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old male with a history of long-standing peripheral artery disease, diabetes mellitus type 2, and tobacco use presents with rest pain and an ischemic ulcer on the distal foot despite optimal medical therapy and prior failed endovascular attempts. Noninvasive arterial studies and angiography demonstrate an occlusive lesion of the superficial femoral artery extending to the popliteal trifurcation with inadequate runoff. The vascular surgeon elects to perform a lower extremity autogenous bypass using the ipsilateral greater saphenous vein from the common femoral artery to the anterior tibial artery to restore limb perfusion.

    The clinical workflow includes preoperative evaluation (vascular lab duplex, arterial angiography, cardiac risk assessment), operative harvesting of the saphenous vein, creation of a femoral-to-tibial bypass conduit (CPT 35585), intraoperative assessment of graft flow, postoperative monitoring in a monitored bed with antiplatelet/anticoagulation management, wound care, and outpatient surveillance with ankle-brachial index and duplex surveillance.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    35600Open embolectomy, thrombectomy, or device-assisted thrombectomy, with or without thrombolysis; arterialPerformed if acute graft thrombosis or native artery thrombus is encountered and requires removal during or after bypass.

    | 36831 | Arteriovenous graft revision, thrombectomy, or repair; for dialysis access — included as example of vascular conduit procedures | May be performed in vascular surgery practice for conduit management; not a direct complement to lower extremity bypass but represents related vascular graft management codes.

    | 37220 | Revascularization, endovascular, open or percutaneous, including angioplasty and stent, femoral-popliteal, unilateral | Used for endovascular attempts performed before or in hybrid combination with CPT 35585 when percutaneous intervention is attempted or adjunctive.

    | 93925 | Noninvasive physiologic studies of extremity arteries, duplex scan of arteries, single level | Used for preoperative and postoperative surveillance of graft patency and limb perfusion.

    | 36147 | Introduction of catheter, arteriovenous cannulation for diagnostic angiography | Used for preoperative diagnostic angiography or intraoperative angiography when catheter-based imaging or runoff studies are performed.

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    2080P0208X
    2084P0800X
    207RH0002X
    229N00000X
    364SP1700X
    261QV0200X
    156FC0800X

    Related Payer Policy Updates

    Specialty: Podiatry1 / 3

    10 rows

    PolicyPayerEffective Date
    Subtalar Joint Implantation (Subtalar Arthroereisis)Cigna2026-10-15
    Surgery of the Foot (for Idaho Only)UnitedHealthcare2026-10-01
    Surgery of the Foot (for North Carolina Only)UnitedHealthcare2026-10-01
    Hallux Limitus or Rigidus (Correction Without Implant)UnitedHealthcare2026-10-01
    Surgery of the Foot (for Kentucky Only)UnitedHealthcare2026-10-01
    Surgery of the Foot (for Kansas Only)UnitedHealthcare2026-10-01
    Surgery of the Foot (for New Mexico Only)UnitedHealthcare2026-10-01
    Surgery of the FootUnitedHealthcare2026-10-01
    Foot Orthoticsuniverahealthcare2026-07-16
    Foot reconstruction procedures: bunionectomy and hallux valgus correction — Medical Necessity Guidelineharvard pilgrim health care2026-06-01

    Related Codes

    CPT-35583-FEMORAL-TO-POPLITEAL-BYPASS-SAPHENOUS-VEIN

    CPT 35583: Femoral-to-Popliteal Bypass with Saphenous Vein

    CPT-35587-POPLITEAL-TO-TIBIAL-VEIN-BYPASS-PERONEAL-ARTERY

    CPT 35587: Popliteal-to-Tibial Artery Bypass with Saphenous Vein

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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