CPT 35612 Subclavian Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35612: Subclavian Artery Bypass with Synthetic Graft

CPT code 35612 identifies a vascular surgical procedure that uses a synthetic graft to bypass an occlusion in the subclavian artery. This operation is a targeted revascularization technique important for restoring upper extremity perfusion and, in select cases, improving vertebrobasilar circulation. Nationally, such procedures carry implications for acute limb ischemia management, stroke prevention strategies related to subclavian steal, and hospital surgical capacity.

Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when CPT code 35612 is used, typical sites of service, and the common modifiers recognized for surgical procedures. The publication outlines benchmarking perspectives and policy-relevant issues affecting billing and coverage for subclavian artery bypass with synthetic grafts, including hospital inpatient versus outpatient considerations and coding clarity for vascular surgery service lines.

This summary equips clinicians, billing professionals, and policy stakeholders with a focused reference on the clinical purpose of CPT code 35612, payer coverage landscape, and the types of operational and reimbursement topics that influence use and reporting of this code.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35612CPTsubclavian-arteryvascular-surgeryarterial-bypasssynthetic-graftsurgical-procedurehospital-inpatient-outpatient

Billing Code Overview

CPT code 35612 describes a surgical procedure in which a provider creates a bypass of a blockage in the subclavian artery using a synthetic graft. The procedure is performed to restore arterial blood flow to the upper extremity or vertebrobasilar circulation when the native subclavian artery is obstructed.

Service type: Vascular surgery — arterial bypass with synthetic graft

Typical site of service: Operating room or surgical suite in an inpatient or outpatient hospital setting, depending on clinical indication and patient status. If additional settings are required by a specific case, Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old smoker with peripheral vascular disease and symptomatic left upper extremity ischemia due to severe subclavian artery atherosclerotic occlusive disease. The patient presents with arm claudication, decreased brachial pulse, and blood pressure discrepancy between arms. Noninvasive testing (duplex ultrasound and CT angiography) demonstrates a high-grade proximal subclavian artery stenosis or occlusion not amenable to percutaneous transluminal angioplasty. The vascular surgery team schedules an open extra-anatomic bypass using a synthetic graft to revascularize the subclavian artery.

Preoperative workflow includes focused history and physical, cardiac risk assessment, medication reconciliation (antiplatelet and anticoagulation planning), and vascular imaging review. In the operating room under general anesthesia, the surgeon exposes the inflow and outflow vessels, sizes and places a synthetic prosthetic graft (e.g., PTFE) to bypass the diseased segment, performs graft anastomoses, confirms graft patency (intraoperative Doppler/angiography), and closes. Postoperative care includes monitoring perfusion of the limb, pain control, wound care, imaging as indicated, and coordinated discharge planning with antiplatelet therapy and vascular risk modification counseling.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — default billing	Use when no specific modifier applies and the service is billed routinely.

CPT 35631: Aortic-to-Visceral/Renal Bypass with Synthetic Graft

CPT-35645-SUBCLAVIAN-TO-VERTEBRAL-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35645: Subclavian-to-Vertebral Artery Bypass with Synthetic Graft

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

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

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

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

CPT-35600-ARTERIAL-GRAFT-HARVEST-ARM-FOR-CORONARY-BYPASS

CPT 35600: Arterial Graft Harvest from Arm for Coronary Bypass

CPT-35663-ILIAC-ARTERY-CROSS-FEMORAL-BYPASS-SYNTHETIC-GRAFT

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

CPT-35621-AXILLOFEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35621: Axillofemoral Bypass Using Synthetic Graft

CPT-35646-AORTO-FEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35646: Aorto-Femoral Bypass with Synthetic Graft

CPT-35632-ILIAC-TO-CELIAC-SYNTHETIC-GRAFT-BYPASS

CPT 35632: Iliac-to-Celiac Synthetic Graft Bypass

CPT-35601-CAROTID-COMMON-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35601: Common Carotid Artery Bypass with Synthetic Graft

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Taxonomy Code	Specialty	Notes
207VG0400X	Vascular Surgery	Primary specialty performing upper extremity and aortic branch bypass procedures.
208200000X	General Surgery	General surgeons with vascular experience may perform this procedure.
2080P0006X	Thoracic Surgery	Thoracic/vascular surgeons may perform proximal subclavian bypass when thoracic exposure required.
207RH0000X	Cardiovascular Surgery	Cardiac/vascular surgeons involved when complex vascular reconstruction is needed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.2`	Atherosclerosis of native arteries of the extremities	Primary disease process leading to subclavian occlusive disease necessitating bypass.
`I70.232`	Atherosclerosis of native arteries of the extremities with intermittent claudication, left arm	Represents symptomatic ischemia of the left upper extremity prompting revascularization.
`I74.3`	Embolism and thrombosis of arteries of the upper extremity	Acute embolic events may require surgical bypass if limb threatened and endovascular therapy unsuitable.
`I65.2`	Occlusion and stenosis of left subclavian artery	Direct anatomic diagnosis indicating the target vessel for bypass.
`G45.9`	Transient cerebral ischemic attack, unspecified	Subclavian steal physiology can cause vertebrobasilar insufficiency; revascularization may address neurologic symptoms.
`I83.90`	Varicose veins of lower extremities with unspecified complications	Not directly related; Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36247`	Introduction of catheter, arterial system; percutaneous, including diagnostic angiography and radiological supervision and interpretation when performed	Often performed preoperatively or intraoperatively for diagnostic angiography or to assist with localization and planning.
`35907`	Endarterectomy, carotid or other cervical artery, with or without patch graft	Alternative or adjunct procedure when concurrent cervical arterial disease is addressed.
`34701`	Peripheral arterial bypass, from axillary to brachial artery, with vein or prosthetic graft	Related extra-anatomic bypass codes; used when inflow/outflow differ and specific anatomic bypass is performed.
`76536`	Duplex scan of extremity arteries or veins; complete bilateral study	Noninvasive vascular testing commonly used pre- and postoperatively to assess graft patency.
`93975`	Duplex scan of extremity arteries, follow-up arterial study	Postoperative surveillance of bypass graft perfusion and flow.

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