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

CPT code 35623 represents an extra-anatomic vascular bypass procedure using a synthetic graft to connect the axillary artery to the popliteal or tibial artery to bypass occlusion of the lower aorta or iliac artery. This complex vascular reconstruction is important nationally for limb salvage and management of severe aortoiliac occlusive disease when standard aortoiliac repair is contraindicated or not feasible. Payers commonly responsible for covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a clinical and billing-focused overview of the procedure, including typical sites of service and service classification. The publication outlines benchmarks relevant to coding and reimbursement, highlights clinical context for when this bypass is indicated, and identifies common billing modifiers and related administrative considerations. It also summarizes payer coverage patterns and policy implications for hospitals and vascular surgery practices. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 35623 describes a surgical bypass procedure in which a synthetic graft is used to bypass an occlusion of the lower aorta or iliac artery by creating a conduit from the axillary artery to a more distal lower-extremity artery such as the popliteal or tibial artery. This procedure is a form of extra-anatomic arterial bypass intended to restore lower-extremity blood flow when standard aortoiliac reconstruction is not feasible.

Service type: Vascular surgical bypass using a synthetic graft
Typical site of service: Inpatient or outpatient hospital operating room, vascular surgery suite, or specialized endovascular/vascular hybrid operating room

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

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Billing Code Overview

Service type: Vascular surgical bypass using a synthetic graft
Typical site of service: Inpatient or outpatient hospital operating room, vascular surgery suite, or specialized endovascular/vascular hybrid operating room

Clinical & Coding Specifications

Clinical Context

A typical patient is a 68-year-old with progressive claudication, resting leg pain, or threatened limb ischemia from severe aortoiliac occlusive disease where inflow from the distal aorta or common iliac arteries is inadequate. After diagnostic angiography and noninvasive vascular testing confirm multilevel occlusive disease unsuitable for endovascular treatment, the vascular surgeon plans an extra-anatomic axillopopliteal or axillotibial bypass using a prosthetic (synthetic) graft. The clinical workflow includes preoperative vascular assessment (ankle-brachial index, duplex ultrasound, CT angiography or diagnostic angiography), medical optimization (antiplatelet therapy, statin therapy, risk-factor control), intraoperative general or regional anesthesia, tunneling of a synthetic graft from the axillary artery subcutaneously to the popliteal or tibial target, completion angiography or duplex to confirm flow, and postoperative surveillance with wound care, anticoagulation or antiplatelet management, and follow-up duplex imaging to assess graft patency. Typical sites of service are inpatient operating room or ambulatory surgical center depending on patient comorbidities and complexity. Service type: Open peripheral vascular bypass surgery.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Data not used as a standard CMS modifier; include only if payer-specific
`11`	Normal or initial service	Primary, normally performed, or first-listed service
`22`	Increased procedural services	Use when complexity or time materially increases work beyond typical
`52`	Reduced services	When a portion of the planned procedure is not completed
`53`	Discontinued procedure	When procedure is terminated for patient safety prior to completion
`62`	Two surgeons	When two surgeons of different specialties perform distinct parts of the operation
`66`	Surgical team	When a surgical team (multiple documented surgeons) performs the procedure
`78`	Unplanned return to OR for related procedure during postoperative period	For a return to OR related to the original operation
`80`	Assistant surgeon	When an assistant at surgery is required and documented
`81`	Minimum assistant surgeon	When a minimum assistant requirement is met and documented
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistants	When an advanced practice clinician performs assistant-at-surgery duties

Taxonomy Code	Specialty	Notes
`2080P0206X`	Vascular Surgery	Primary specialty performing axillopopliteal/axillotibial bypass
`208000000X`	General Surgery	General surgeons with vascular expertise may perform procedure
`207RP1001X`	Thoracic and Cardiac Surgery	May be involved when complex proximal aortic/axillary exposure is required
`2084P0800X`	Interventional Cardiology	Rarely involved; primarily for diagnostic angiography and hybrid procedures
`363LP0800X`	Physician Assistant	Common assistant provider in vascular surgery cases

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.201`	Atherosclerosis of native arteries of the extremities, right leg, unspecified	Aortoiliac and femoropopliteal atherosclerotic disease causing limb ischemia amenable to axillopopliteal bypass
`I70.202`	Atherosclerosis of native arteries of the extremities, left leg, unspecified	Same as above for left lower extremity
`I70.211`	Atherosclerosis of native arteries of the extremities with intermittent claudication, right leg	Intermittent claudication from peripheral arterial disease often leading to bypass when severe
`I70.212`	Atherosclerosis of native arteries of the extremities with intermittent claudication, left leg	As above for left leg
`I70.231`	Atherosclerosis of native arteries of the extremities with ulceration, right leg	Critical limb ischemia with tissue loss may necessitate bypass for limb salvage
`I70.232`	Atherosclerosis of native arteries of the extremities with ulceration, left leg	As above for left leg
`I70.241`	Atherosclerosis of native arteries of the extremities with rest pain, right leg	Rest pain indicates critical ischemia requiring revascularization such as bypass
`I70.242`	Atherosclerosis of native arteries of the extremities with rest pain, left leg	As above for left leg

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35623`	Axillary artery to popliteal or tibial artery bypass with synthetic graft	Primary procedure: extra-anatomic bypass using a synthetic graft to bypass aortoiliac occlusion to distal popliteal or tibial targets
`34400`	Repair of axillary artery, open; with graft	May describe proximal axillary artery exposure or repair when performed concurrently
`35301`	Thrombectomy, femoral or popliteal artery; with thrombolytic agent	Performed when acute graft or native vessel thrombosis requires removal prior to or during bypass
`36147`	Introduction of catheter, arterial, radiological supervision and interpretation, each vessel	Diagnostic or completion angiography of run-off vessels intra- or post-procedure
`75960`	Direct puncture and catheterization for radiological supervision and interpretation; percutaneous transluminal angioplasty, each additional vessel (List separately in addition to primary)	Used in hybrid cases when endovascular adjunct angioplasty is performed on runoff vessels
`36818`	Endovascular revascularization, femoral-popliteal, with transluminal angioplasty	May be performed before or after bypass in hybrid or staged limb salvage strategies

CPT 35600: Arterial Graft Harvest from Arm for Coronary Bypass

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

CPT 35601: Common Carotid Artery Bypass with Synthetic Graft

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

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

CPT-35606-SUBCLAVIAN-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35606: Subclavian Artery Bypass with Synthetic Graft

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

CPT 35612: Subclavian Artery Bypass with Synthetic Graft

CPT-35616-SUBCLAVIAN-TO-AXILLARY-BYPASS-SYNTHETIC-GRAFT

CPT 35616: Subclavian-to-Axillary Bypass with Synthetic Graft

CPT-35621-AXILLOFEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35621: Axillofemoral Bypass Using Synthetic Graft

CPT-35626-AORTIC-TO-SUBCLAVIAN-INNOMINATE-CAROTID-BYPASS-GRAFT

CPT 35626: Aortic-to-Subclavian/Innominate/Carotid Bypass with Synthetic Graft

CPT-35631-AORTO-VISCERAL-RENAL-BYPASS-SYNTHETIC-GRAFT

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

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

CPT 35632: Iliac-to-Celiac Synthetic Graft Bypass

Showing 1–10 of 27

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Data not used as a standard CMS modifier; include only if payer-specific
`11`	Normal or initial service	Primary, normally performed, or first-listed service
`22`	Increased procedural services	Use when complexity or time materially increases work beyond typical
`52`	Reduced services	When a portion of the planned procedure is not completed
`53`	Discontinued procedure	When procedure is terminated for patient safety prior to completion
`62`	Two surgeons	When two surgeons of different specialties perform distinct parts of the operation
`66`	Surgical team	When a surgical team (multiple documented surgeons) performs the procedure
`78`	Unplanned return to OR for related procedure during postoperative period	For a return to OR related to the original operation
`80`	Assistant surgeon	When an assistant at surgery is required and documented
`81`	Minimum assistant surgeon	When a minimum assistant requirement is met and documented
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistants	When an advanced practice clinician performs assistant-at-surgery duties

Taxonomy Code	Specialty	Notes
`2080P0206X`	Vascular Surgery	Primary specialty performing axillopopliteal/axillotibial bypass
`208000000X`	General Surgery	General surgeons with vascular expertise may perform procedure
`207RP1001X`	Thoracic and Cardiac Surgery	May be involved when complex proximal aortic/axillary exposure is required
`2084P0800X`	Interventional Cardiology	Rarely involved; primarily for diagnostic angiography and hybrid procedures
`363LP0800X`	Physician Assistant	Common assistant provider in vascular surgery cases

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.201`	Atherosclerosis of native arteries of the extremities, right leg, unspecified	Aortoiliac and femoropopliteal atherosclerotic disease causing limb ischemia amenable to axillopopliteal bypass
`I70.202`	Atherosclerosis of native arteries of the extremities, left leg, unspecified	Same as above for left lower extremity
`I70.211`	Atherosclerosis of native arteries of the extremities with intermittent claudication, right leg	Intermittent claudication from peripheral arterial disease often leading to bypass when severe
`I70.212`	Atherosclerosis of native arteries of the extremities with intermittent claudication, left leg	As above for left leg
`I70.231`	Atherosclerosis of native arteries of the extremities with ulceration, right leg	Critical limb ischemia with tissue loss may necessitate bypass for limb salvage
`I70.232`	Atherosclerosis of native arteries of the extremities with ulceration, left leg	As above for left leg
`I70.241`	Atherosclerosis of native arteries of the extremities with rest pain, right leg	Rest pain indicates critical ischemia requiring revascularization such as bypass
`I70.242`	Atherosclerosis of native arteries of the extremities with rest pain, left leg	As above for left leg

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35623`	Axillary artery to popliteal or tibial artery bypass with synthetic graft	Primary procedure: extra-anatomic bypass using a synthetic graft to bypass aortoiliac occlusion to distal popliteal or tibial targets
`34400`	Repair of axillary artery, open; with graft	May describe proximal axillary artery exposure or repair when performed concurrently
`35301`	Thrombectomy, femoral or popliteal artery; with thrombolytic agent	Performed when acute graft or native vessel thrombosis requires removal prior to or during bypass
`36147`	Introduction of catheter, arterial, radiological supervision and interpretation, each vessel	Diagnostic or completion angiography of run-off vessels intra- or post-procedure
`75960`	Direct puncture and catheterization for radiological supervision and interpretation; percutaneous transluminal angioplasty, each additional vessel (List separately in addition to primary)	Used in hybrid cases when endovascular adjunct angioplasty is performed on runoff vessels
`36818`	Endovascular revascularization, femoral-popliteal, with transluminal angioplasty	May be performed before or after bypass in hybrid or staged limb salvage strategies

CPT 35600: Arterial Graft Harvest from Arm for Coronary Bypass

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

CPT 35601: Common Carotid Artery Bypass with Synthetic Graft

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

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

CPT-35606-SUBCLAVIAN-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35606: Subclavian Artery Bypass with Synthetic Graft

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

CPT 35612: Subclavian Artery Bypass with Synthetic Graft

CPT-35616-SUBCLAVIAN-TO-AXILLARY-BYPASS-SYNTHETIC-GRAFT

CPT 35616: Subclavian-to-Axillary Bypass with Synthetic Graft

CPT-35621-AXILLOFEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35621: Axillofemoral Bypass Using Synthetic Graft

CPT-35626-AORTIC-TO-SUBCLAVIAN-INNOMINATE-CAROTID-BYPASS-GRAFT

CPT 35626: Aortic-to-Subclavian/Innominate/Carotid Bypass with Synthetic Graft

CPT-35631-AORTO-VISCERAL-RENAL-BYPASS-SYNTHETIC-GRAFT

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

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

CPT 35632: Iliac-to-Celiac Synthetic Graft Bypass

Showing 1–10 of 27

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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

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Billing Code Overview

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

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References