CPT 35606 Subclavian Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35606: Subclavian Artery Bypass with Synthetic Graft

CPT code 35606 identifies an open vascular bypass procedure using a synthetic graft to bypass a blockage in the subclavian artery. This operation restores arterial inflow to the upper extremity and can protect cerebral perfusion when vertebral circulation is at risk. As an operative vascular code, it carries implications for inpatient surgical scheduling, perioperative resource use, and reimbursement across major national payers.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, common modifiers used with operative codes, and where to look for coding and billing guidance. The publication provides benchmarks and payer policy summaries, highlights documentation elements relevant to surgical vascular bypass, and outlines areas where payers commonly apply medical necessity reviews or prior authorization requirements.

This summary is intended for billing managers, vascular surgeons, revenue cycle professionals, and policy analysts seeking a national-level briefing on coding considerations and payer engagement for synthetic subclavian artery bypass procedures represented by CPT code 35606.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35606CPTvascular-surgerysubclavian-arterybypasssynthetic-graftinpatient-surgeryoperative-coding

Billing Code Overview

CPT code 35606 describes a surgical procedure in which a synthetic graft is used to bypass an occlusion or stenosis of the subclavian artery. The procedure establishes an alternate conduit to restore blood flow to the affected upper extremity or vertebrobasilar circulation.

Service type: Open vascular bypass using a synthetic conduit
Typical site of service: Hospital operating room or inpatient surgical suite

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old man with symptomatic left arm claudication, coolness, and diminished pulses due to atherosclerotic occlusive disease of the subclavian artery. Noninvasive testing (duplex ultrasound, CT angiography) demonstrates a high-grade proximal left subclavian stenosis or occlusion not amenable to percutaneous intervention or with prior failed angioplasty. The vascular surgery team schedules an elective open bypass procedure using a synthetic graft (eg, PTFE) from the carotid or axillary artery to the distal subclavian/axillary artery to re-establish upper extremity inflow. Preoperative workflow includes vascular lab imaging, cardiopulmonary risk assessment, medication management (antiplatelet, anticoagulation review), and informed consent for potential blood loss and nerve injury. Intraoperative workflow involves general anesthesia, exposure of inflow and outflow vessels, tunneling of the synthetic graft, completion angiography or Doppler confirmation of graft patency, and hemostasis. Postoperative care includes monitoring in a surgical ward or stepdown unit for limb perfusion, graft patency checks, pain control, wound care, and planning for antiplatelet therapy and follow-up vascular imaging.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the physician professional component of a service (rare for this surgical procedure; relevant if separate technical facility reporting occurs).

CPT 35663: Iliac Artery Cross-Femoral Bypass with Synthetic Graft

CPT-35665-ILIAC-TO-FEMORAL-SYNTHETIC-GRAFT-BYPASS

CPT 35665: Iliac-to-Femoral Bypass with Synthetic Graft

CPT-35661-FEMORAL-FEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35661: Femoral–Femoral Bypass with Synthetic Graft

CPT-35654-AXILLARY-FEMORAL-BYPASS-NON-VEIN-GRAFT

CPT 35654: Axillary to Femoral Bypass Using Non-Vein Graft

CPT-35671-POPLITEAL-TO-TIBIAL-PERONEAL-BYPASS-SYNTHETIC-GRAFT

CPT 35671: Popliteal to Tibial/Peroneal Bypass with Synthetic Graft

CPT-35650-AXILLARY-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35650: Axillary Artery Bypass with Synthetic Graft

CPT-35642-CAROTID-TO-VERTEBRAL-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35642: Carotid-to-Vertebral Artery Bypass with Synthetic Graft

CPT-35623-AXILLARY-TO-POPLITEAL-OR-TIBIAL-BYPASS-SYNTHETIC-GRAFT

CPT 35623: Axillary-to-Popliteal/Tibial Bypass with Synthetic Graft

CPT-35602-CAROTID-TO-CAROTID-PROSTHETIC-ARTERIAL-BYPASS

CPT 35602: Carotid-to-Carotid Bypass Using Prosthetic Graft

CPT-35637-AORTO-ILIAC-BYPASS-WITH-SYNTHETIC-GRAFT

CPT 35637: Aorto-Iliac Bypass Using Synthetic Graft

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Taxonomy Code	Specialty	Notes
`207RX0400X`	Vascular Surgery	Primary specialty performing open subclavian bypass procedures.
`208D00000X`	Thoracic and Cardiac Surgery	May perform when concomitant proximal thoracic vessel exposure is required.
`2080S0005X`	General Surgery	General surgeons with vascular training in centers without dedicated vascular surgeons.
`207L00000X`	Interventional Cardiology	Rarely involved for hybrid cases combining endovascular and open techniques.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.2`	Atherosclerosis of native arteries of the extremities	Common underlying cause of subclavian occlusive disease requiring bypass.
`I74.3`	Embolism and thrombosis of arteries of the lower extremities	Not directly applicable to subclavian; Data not available in the input.
`I77.1`	Stricture of artery	May describe focal arterial stenosis amenable to bypass.
`I65.2`	Occlusion and stenosis of subclavian artery	Direct diagnosis indicating subclavian artery occlusion/stenosis requiring revascularization.
`G46.3`	Vascular syndromes of brain in cerebrovascular diseases	Not directly applicable; Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35606`	Bypass graft, with other than vein; subclavian artery	Primary procedure: synthetic graft bypass to bypass subclavian obstruction.
`34002`	Thromboendarterectomy, without patch, subclavian artery	Alternative or adjunct open procedure addressing atherosclerotic plaque in the subclavian artery.
`35556`	Endarterectomy, brachiocephalic artery, with or without patch	Performed when disease involves proximal great vessels and combined inflow procedures are necessary.
`36147`	Insertion of arterial sheath, radiologic; any method	Used if intraoperative angiography or endovascular access is performed for completion imaging or hybrid repair.
`75710`	Angiography, extremity, unilateral, radiological supervision and interpretation	Completion angiography to confirm graft patency performed intra- or post-operatively.

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