CPT 35621 Axillofemoral Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35621: Axillofemoral Bypass Using Synthetic Graft

CPT code 35621 represents an axillofemoral bypass using a synthetic graft to circumvent occlusive disease of the lower aorta or iliac arteries. The procedure is clinically significant for patients with severe aortoiliac occlusive disease or when traditional aortic reconstruction is contraindicated. Nationally, this code tracks use of extra-anatomic bypass techniques that preserve limb perfusion when endovascular or direct aortic approaches are unsuitable.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of the procedure, typical sites of service, and clinical context. The publication outlines common billing considerations, commonly reported modifiers, and where available, payer coverage patterns and policy nuances. It also situates CPT code 35621 within the broader vascular surgery service line and highlights implications for provider coding workflows and claims processing.

This summary serves clinicians, billing professionals, and policy analysts seeking a national overview of the code’s clinical use, billing context, and payer landscape. Data not available in the input is identified where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35621axillofemoral bypassvascular surgerysynthetic graftoperating roominpatient surgeryambulatory surgical centersurgical bypassaortoiliac occlusive disease

Billing Code Overview

CPT code 35621 describes a surgical bypass procedure in which a synthetic graft is used to create a connection between the axillary artery and the femoral artery to bypass an obstruction of the lower aorta or iliac artery. This operation is performed to restore arterial blood flow to the lower extremities when more direct aortoiliac bypass is not feasible.

Service type: Vascular surgical bypass using synthetic graft
Typical site of service: Inpatient or ambulatory surgical center with vascular surgery capability (operating room)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with progressive claudication, rest pain in the lower extremities, and imaging-confirmed severe aortoiliac occlusive disease (chronically occluded infrarenal aorta and bilateral common iliac arteries) is scheduled for revascularization. The vascular surgery team plans an extra-anatomic axillofemoral bypass using a synthetic graft to restore perfusion to the lower extremity by connecting the axillary artery to the femoral artery (CPT 35621). Preoperative workup includes arterial duplex ultrasound and CT angiography, cardiopulmonary risk assessment, and informed consent discussing limb salvage and graft patency expectations. The procedure is performed in an operating room under general or regional anesthesia with vascular surgery or cardiothoracic-vessel trained surgeons and perioperative vascular access and monitoring. Postoperative care includes anticoagulation management, wound and graft surveillance, and vascular imaging follow-up to assess patency and limb perfusion.

Coding Specifications

Modifier	Description	When to Use
`00`	No specific modifier — standard reporting	Use for standard, complete procedures with no additional modifier indicated

| 11 | Office or other outpatient setting (CMS sometimes uses for providers' internal purposes) | Rarely used for this inpatient/OR procedure; not typical but may appear for claims systems that require a default primary modifier |

CPT 35666: Femoral-to-Tibial/Peroneal Bypass with Synthetic Graft

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

CPT 35645: Subclavian-to-Vertebral 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-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

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

CPT 35661: Femoral–Femoral Bypass with Synthetic Graft

CPT-35612-SUBCLAVIAN-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35612: Subclavian Artery Bypass with Synthetic Graft

CPT-35636-SPLENIC-TO-RENAL-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35636: Splenic-to-Renal Artery Bypass with Synthetic Graft

CPT-35633-ILIAC-TO-MESENTERIC-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35633: Iliac-to-Mesenteric Artery Bypass with Synthetic Graft

CPT-35656-FEMORAL-TO-POPLITEAL-BYPASS-SYNTHETIC-GRAFT

CPT 35656: Femoral-to-Popliteal Bypass with Synthetic Graft

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Taxonomy Code	Specialty	Notes
`208800000X`	Vascular Surgery	Primary specialty performing open axillofemoral bypass and aortoiliac revascularization

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.2`	Atherosclerosis of native arteries of the extremities	Peripheral atherosclerotic disease causing aortoiliac occlusive lesions addressed by axillofemoral bypass

| I70.21 | Atherosclerosis of native arteries of the extremities with intermittent claudication | Symptom driving revascularization to improve functional status and walking distance |

| I70.23 | Atherosclerosis of native arteries of the extremities with gangrene | Severe ischemia risking limb loss, indication for urgent revascularization such as CPT 35621 |

| I74.3 | Embolism and thrombosis of arteries of the lower extremity | Acute or chronic thrombotic/embolic disease that may necessitate bypass if endovascular options fail |

| I77.1 | Stricture of artery | Focal arterial occlusion or stenosis in the aortoiliac segment that can be managed with bypass when anatomy is unsuitable for endovascular repair |

| Z95.2 | Presence of prosthetic arterial graft | Relevant for patients with prior grafts who require additional or revision bypass procedures |

| I96 | Gangrene, not elsewhere classified | Severe ischemic complication that may prompt revascularization to salvage limb |

| E11.51 | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene | Diabetes with advanced peripheral vascular disease increasing need for surgical bypass to restore perfusion |

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36147`	Arterial catheterization or cannulation for diagnostic or therapeutic injection, percutaneous, femoral, brachial or axillary, including diagnostic angiography when performed	Commonly performed preoperatively or intraoperatively for angiographic assessment or distal run-off evaluation prior to `CPT 35621`

| 35566 | Thromboendarterectomy, iliac artery, with or without patch graft | Performed in alternative open aortoiliac reconstructions; may be performed in same patient if focal lesions are amenable to endarterectomy rather than extra-anatomic bypass |

| 35102 | Graft, bypass, or bypass graft, femoral-femoral bypass, prosthetic graft | Femoral-femoral bypass is an alternative extra-anatomic revascularization; may be considered in similar clinical workflows or performed sequentially in staged procedures |

| 36818 | Introduction of tunneled intravascular catheter, dialysis or long term | May be billed when long-term vascular access is needed in complex vascular patients (contextual ancillary service) |

| 93975 | Duplex scan of extremity arteries, bilateral study | Noninvasive testing used preoperatively and postoperatively to assess arterial disease and graft patency |

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