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    v1.0.30
    OpenPayerBilling CodesBypass Graft Procedures Other Than VeinCPT cpt-35623-axillary-to-popliteal-or-tibial-bypass-synthetic-graft
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    CPT 35623: Axillofemoral to Popliteal/Tibial Bypass with Synthetic Graft

    Medicare pays $1194 on average nationally for this procedure.

    CPT code 35623 describes a surgical bypass using a synthetic graft to route blood from the axillary artery to a popliteal or tibial artery to circumvent blockage of the lower aorta or iliac artery; this is a vascular bypass procedure typically classified as open peripheral arterial bypass surgery performed in an operating room or other inpatient/outpatient surgical setting and documented as a specific CPT surgical service for limb revascularization.

    For related coverage guidance, see recent payer policy updates: Surgical Procedures, Outpatient Surgical Procedures - Site of Service, Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults.

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    Table of contents

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    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    35623Axillary artery to popliteal or tibial artery bypass with synthetic graftPrimary procedure: extra-anatomic bypass using a synthetic graft to bypass aortoiliac occlusion to distal popliteal or tibial targets
    34400Repair of axillary artery, open; with graftMay describe proximal axillary artery exposure or repair when performed concurrently
    35301Thrombectomy, femoral or popliteal artery; with thrombolytic agentPerformed when acute graft or native vessel thrombosis requires removal prior to or during bypass
    36147Introduction of catheter, arterial, radiological supervision and interpretation, each vesselDiagnostic or completion angiography of run-off vessels intra- or post-procedure
    75960Direct 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
    36818Endovascular revascularization, femoral-popliteal, with transluminal angioplastyMay be performed before or after bypass in hybrid or staged limb salvage strategies

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2080P0206X
    208000000X
    207RP1001X
    2084P0800X
    207PS0010X
    261QM0801X
    2081P0010X
    1223P0300X

    Related Payer Policy Updates

    Specialty: General Surgery1 / 2

    10 rows

    PolicyPayerEffective Date
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01
    Medical Necessity Guidelines — Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Ambulatory Surgery Center (ASC) - Site of Care PolicyKaiser Permanente2026-08-01

    Related Codes

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

    CPT 35600: Arm Artery Harvest 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 with 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: Axillary–Femoral Bypass with 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: Aorto-Visceral Bypass with Synthetic Graft

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

    CPT 35632: Iliac-to-Celiac Arterial Bypass with Synthetic Graft

    Showing 1–10 of 27

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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