Summary & Overview
CPT 35626: Aortic-to-Subclavian/Innominate/Carotid Bypass with Synthetic Graft
Headline: CPT code 35626 covers open aortic-to-artery bypass grafting to bypass major branch obstructions.
Lead: CPT code 35626 describes an open vascular surgery in which a synthetic graft is used to reroute blood flow from the aorta around an occluded aortosubclavian, aortoinnominate, or aortocarotid artery. This procedure restores perfusion to the head, neck, or upper extremity and is performed in operative, typically inpatient, settings.
CPT code 35626 matters nationally because it represents a high-acuity vascular reconstruction with implications for hospital resource use, perioperative risk management, and payer coverage policies. Key payers considered in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will gain a clear understanding of: the clinical intent and procedural context for CPT code 35626; the typical service setting and resource implications; the range of modifiers commonly applied to complex surgical encounters (listed separately); and where to look for related coding or coverage guidance. The publication provides benchmarks and policy-relevant observations about billing classifications and clinical context without state-specific references. Data not available in the input for some comparative metrics is noted where applicable.
Billing Code Overview
CPT code 35626 describes a surgical bypass procedure using a synthetic graft to reroute blood flow from the aorta around an obstructed branch of the major arteries supplying the head and upper extremity. The procedure addresses blockages in the aortosubclavian, aortoinnominate, or aortocarotid arteries by creating a new connection from the aorta to the affected artery beyond the obstruction.
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Service type: Open vascular bypass surgery using a synthetic graft
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Typical site of service: Inpatient hospital or operating room setting for vascular surgery
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with progressive right upper extremity exertional fatigue, pallor, and a 3-month history of claudication and blood pressure discrepancy between arms is evaluated by vascular surgery. Noninvasive testing (duplex ultrasound and CTA of the chest/neck) demonstrates a high-grade atherosclerotic occlusion of the right subclavian artery near its origin from the aortic arch. Medical management with antiplatelet therapy and risk-factor modification has been attempted. Due to symptomatic ischemia of the right arm and evidence of hemodynamically significant proximal subclavian stenosis not amenable to percutaneous intervention, the vascular surgeon schedules an aortosubclavian bypass using a synthetic graft (CPT 35626).
The clinical workflow includes preoperative cardiac and pulmonary risk assessment, informed consent, perioperative antibiotics, general anesthesia, central monitoring, surgical exposure of the aorta and target subclavian artery, proximal aortic anastomosis of a synthetic graft, distal anastomosis to the subclavian artery bypassing the lesion, intraoperative Doppler/angiography to confirm flow, hemostasis, and postoperative monitoring in a step-down or intensive care setting with vascular checks and antiplatelet therapy on discharge. Typical site of service is an inpatient operating room within a tertiary or community hospital. Service type: open vascular surgical bypass (major vascular surgery).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |