CPT 35587 Popliteal-to-Tibial Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35587: Popliteal-to-Tibial Bypass Using Saphenous Vein

CPT code 35587 represents a popliteal-to-tibial arterial bypass using the patient’s saphenous vein to bypass a peroneal artery occlusion. This vascular surgery code is central to management of peripheral arterial disease and limb ischemia, where restoring distal blood flow can prevent tissue loss and reduce the need for amputation. Nationally, surgical revascularization remains a key element of vascular care pathways for patients with critical limb ischemia.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical care settings, and common billing considerations for CPT code 35587. The publication summarizes benchmark elements and policy-relevant details that affect coverage and billing for lower-extremity bypass procedures, and it provides guidance on where to seek payer-specific coverage rules and documentation expectations.

This summary is intended for administrators, coding specialists, and clinicians seeking a national-level briefing on CPT code 35587, offering a clear starting point for more detailed review of payer policies, reimbursement benchmarks, and clinical documentation requirements.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35587lower extremity bypassperipheral arterial diseasevascular surgerypopliteal tibial bypasssaphenous vein graftlimb ischemiasurgical revascularizationhospital outpatient surgery

Billing Code Overview

CPT code 35587 describes a surgical revascularization procedure in which the provider performs a popliteal to tibial artery bypass using the patient’s saphenous vein to bypass a blockage in the peroneal artery. The procedure is performed to restore blood circulation to the lower extremity and treat limb ischemia related to occlusive peripheral arterial disease.

Service type: Surgical arterial bypass (lower extremity revascularization)
Typical site of service: Inpatient or outpatient hospital operating room and vascular surgery settings

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with long-standing peripheral arterial disease and poorly controlled diabetes presents with rest pain and an ischemic ulcer on the lateral aspect of the left foot. Noninvasive vascular testing shows diminished ankle-brachial indices and duplex ultrasound demonstrates a flow-limiting occlusion of the left peroneal artery with inadequate distal runoff. The vascular surgery team elects to perform a popliteal-to-tibial bypass using the patient’s autologous greater saphenous vein to restore direct in-line flow to the tibial/peroneal runoff and promote wound healing.

Preoperative workflow includes history and physical, review of cardiac risk and optimization, arterial imaging (duplex ultrasound and CT angiography), vein mapping to confirm conduit suitability, consent for bypass and possible adjunct procedures, and anesthesia evaluation. In the operating room under general or regional anesthesia, the surgeon harvests the saphenous vein, prepares inflow at the distal popliteal artery, tunnels the vein graft to the target tibial artery (to bypass the peroneal occlusion), performs end-to-side anastomoses, confirms graft patency with intraoperative Doppler/angiography, and closes wounds. Postoperative care includes anticoagulation or antiplatelet management, limb monitoring, wound care, and surveillance imaging to assess graft patency and guide secondary interventions if needed.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal or routine service

CPT 35585: Femoral-to-Tibial/Peroneal Bypass Using Saphenous Vein

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

CPT 35583: Femoral to Popliteal Bypass Using Saphenous Vein

Taxonomy Code	Specialty	Notes
`208800000X`	Vascular Surgery	Primary specialty performing lower extremity bypass procedures.
`208600000X`	Thoracic and Cardiovascular Surgery	Also trained to perform peripheral bypass in some centers.
`207P00000X`	Physician Assistant	Frequently assists in perioperative and intraoperative care.
`208D00000X`	General Surgery	May perform peripheral bypass procedures in certain settings.
`363LP0800X`	Anesthesiology	Provides general/regional anesthesia and perioperative management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.213`	Atherosclerosis of native arteries of extremities with intermittent claudication, left leg	Common underlying cause of peroneal artery occlusion leading to bypass.
`I70.233`	Atherosclerosis of native arteries of extremities with ulceration, left leg	Ischemic ulceration that often prompts revascularization via bypass.
`I70.245`	Atherosclerosis of native arteries of extremities with gangrene, left leg	Severe ischemia with tissue loss where bypass may be indicated to salvage limb.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute occlusive events that can necessitate revascularization or bypass.
`I70.22`	Atherosclerosis of native arteries of extremities with rest pain, left leg	Rest pain is an indication for urgent bypass to relieve ischemia.
`E11.51`	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	Diabetes is a major risk factor for peripheral arterial disease and limb ischemia prompting bypass.
`L97.422`	Non-pressure chronic ulcer of left heel and midfoot with fat layer exposed	Chronic nonhealing foot ulcer that may require revascularization to heal.
`Z95.2`	Presence of prosthetic vascular graft and prosthetic bypass	Relevant for history and surveillance when considering revisions or new bypass grafting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35587`	Popliteal to tibial artery bypass, with vein; in situ or reversed, autogenous vein graft	Primary procedure: creation of a popliteal-to-tibial bypass using the saphenous vein to bypass a peroneal artery occlusion.
`35656`	Thromboembolectomy, with or without arteriotomy; tibial-peroneal trunk, each artery separately	May be performed prior to or with bypass if thromboembolism contributes to acute occlusion requiring clearance before grafting.
`35102`	Endarterectomy, femoral artery with patch graft (separate CPTs vary)	May be performed in the same operative setting to optimize inflow when multilevel disease is present.
`36247`	Endovascular mechanical thrombectomy; peripheral, any method	May be used as an adjunct or alternative in hybrid procedures to restore runoff before or instead of bypass.
`93925`	Duplex scan of arterial inflow and outflow, complete bilateral study	Used in pre- and postoperative assessment of inflow and graft patency; often performed in the perioperative workflow.
`76010`	Fluoroscopic guidance and localization of needle or catheter; radiological supervision and interpretation	May be used intraoperatively for angiography to confirm anastomotic patency or guide hybrid interventions.

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