Summary & Overview
CPT 35616: Subclavian-to-Axillary Bypass with Synthetic Graft
CPT code 35616 represents an open vascular bypass procedure using a synthetic graft to connect the subclavian artery to the axillary artery and bypass a proximal arterial occlusion. This procedure is clinically important for restoring upper-extremity arterial inflow when medical therapy or endovascular measures are insufficient or infeasible. Nationally, it affects hospital vascular surgery services, resource utilization in operating rooms, and post-operative inpatient care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for utilization and payment practices across major payers, clinical context that explains when surgical subclavian–axillary bypass is indicated, and policy-relevant considerations affecting coverage and site-of-service decisions. The publication outlines typical sites of service, expected clinical workflow, and common billing elements associated with the procedure. Data not available in the input is identified where applicable. This summary is intended for hospital administrators, billing and coding professionals, and vascular clinicians seeking a concise, national-level overview of CPT code 35616 and its implications for care delivery and reimbursement.
Billing Code Overview
CPT code 35616 describes a surgical bypass procedure in which a synthetic graft is used to bypass an occlusion of the subclavian artery by creating a conduit between the subclavian artery and the axillary artery. This is a vascular bypass surgery intended to restore arterial blood flow to the upper extremity when native arterial segments are blocked or unsuitable for repair.
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Service type: Open vascular surgical bypass using a synthetic graft
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Typical site of service: Inpatient hospital operating room or specialized vascular surgery suite
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with symptomatic left upper extremity ischemia presents with exertional arm fatigue, claudication, and a blood pressure difference >20 mm Hg between arms. Noninvasive testing (duplex ultrasound and CT angiography) demonstrates a high-grade atherosclerotic stenosis or occlusion of the proximal left subclavian artery proximal to the origin of the vertebral artery. After multidisciplinary review, the vascular surgery team performs an open bypass using a synthetic graft to connect the left subclavian artery to the ipsilateral axillary artery to restore antegrade flow and relieve ischemic symptoms. The clinical workflow includes preoperative imaging and cardiopulmonary evaluation, informed consent, general anesthesia, surgical exposure of the subclavian and axillary arteries, graft selection and tunneling, completion angiography or duplex to confirm patency, hemostasis and wound closure, postoperative monitoring in PACU with neurovascular checks, and follow-up duplex surveillance in clinic. Typical site of service is an inpatient or outpatient hospital operating room or ambulatory surgery center depending on comorbidities and institutional practice. Service type is a vascular open arterial bypass procedure using a synthetic graft.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier - full modifier field blank is standard in some systems | Use when no special circumstances or modifiers apply to the service |