Summary & Overview
CPT 35585: Femoral-to-Tibial/Peroneal Bypass Using Saphenous Vein
CPT code 35585 represents femoral-to-tibial or femoral-to-peroneal arterial bypass surgery using the patient's saphenous vein to reestablish lower-extremity blood flow. This vascular surgical procedure is critical for treating limb ischemia caused by arterial occlusive disease and can be limb-saving when endovascular approaches are not feasible or have failed. Nationally, such open bypass procedures remain an important component of vascular surgery portfolios, with implications for operative resource use, postoperative care, and long-term limb salvage.
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 CPT code 35585, standard service and site-of-service expectations, and the types of benchmarks and policy elements typically relevant to this procedure. The publication also highlights how payers and Medicare approach coverage and coding considerations for open arterial bypass, and what metrics—such as utilization rates, length of stay, and post-surgical outcomes—are commonly evaluated. Data not available in the input is noted where specific payer policies, associated taxonomies, ICD-10 diagnoses, related codes, and granular benchmarks would normally appear.
Billing Code Overview
CPT code 35585 describes a surgical arterial bypass procedure in which the provider creates a femoral-to-anterior tibial, femoral-to-posterior tibial, or femoral-to-peroneal artery bypass using the patient's saphenous vein to bypass an arterial blockage. The procedure is performed to restore blood circulation to the lower extremity.
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Service type: Lower extremity arterial bypass surgery using autologous saphenous vein graft
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Typical site of service: Hospital operating room or inpatient surgical setting
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; primary unadjusted claim submission | Use when no special circumstance applies and service is billed as provided. |
| 11 | Office or other outpatient visit (POS 11) — not a standard CMS modifier for surgical circumstance but listed in input | Use as place-of-service indicator on claims when required by payer for outpatient surgery billing.