CPT 35631 Aorto-Visceral Bypass Reimbursement | OpenPayer

Summary & Overview

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

CPT code 35631 represents an open vascular bypass procedure using a synthetic graft to reroute blood flow from the aorta around an occlusion in a celiac, mesenteric, or renal artery. This procedure is clinically significant for restoring visceral or renal perfusion and can be critical for preventing organ ischemia, loss of function, or life-threatening complications. Nationally, such arterial bypass procedures are a component of vascular surgery services subject to payer coverage policies, prior authorization practices, and quality reporting for major vascular interventions.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of coverage considerations and common billing practice elements tied to this code, and summarizes benchmarks where available. Readers will find clinical context explaining the procedure type and typical site of service, a review of common modifiers used with major vascular procedures, and guidance on where to locate relevant payer policies and Medicare coding references. Data not available in the input is noted explicitly where applicable. The content is written for a national audience and focuses on code definition, payer landscape, and practical billing context rather than state-specific rules or clinical recommendations.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35631CPTvascular-surgeryaorto-visceral-bypassrenal-artery-bypasssynthetic-graftinpatient-surgeryarterial-bypass

Billing Code Overview

CPT code 35631 describes a surgical arterial bypass using a synthetic graft to reroute blood flow from the aorta around a blockage in a celiac, mesenteric, or renal artery. The service involves creation of an aorto-to-visceral or aorto-to-renal bypass conduit using a prosthetic graft to restore perfusion to the affected organ bed.

Service type: Open vascular bypass surgery using a prosthetic (synthetic) graft
Typical site of service: Inpatient or outpatient hospital operating room; vascular surgery suite for major open arterial bypass procedures

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of long-standing atherosclerotic cardiovascular disease, hypertension, hyperlipidemia, and chronic smoking presents with postprandial abdominal pain, unintentional weight loss, and food fear consistent with chronic mesenteric ischemia. Noninvasive imaging (CT angiography) demonstrates high-grade stenosis/occlusion of the superior mesenteric artery and involvement of the celiac axis. After multidisciplinary review, the vascular surgeon elects to perform an open aorto-mesenteric/mesenteric bypass using a synthetic graft to restore mesenteric perfusion.

The clinical workflow includes preoperative evaluation with cardiopulmonary clearance, consent and documentation of indications and risks, intraoperative exposure of the abdominal aorta and target mesenteric or celiac/renal artery, placement of a prosthetic graft from the aorta to the affected artery to bypass the occlusion, hemostasis, and postoperative monitoring in a step-down or intensive care setting. Perioperative documentation includes operative report with graft type and anastomosis sites, estimated blood loss, any intraoperative complications, use of blood products, and detailed discharge instructions including antiplatelet/anticoagulation management and follow-up imaging to assess graft patency.

Coding Specifications

Modifier	Description	When to Use
`00`	Default; no modifier	Use when no specific modifier applies and standard reporting is appropriate.

CPT 35661: Femoral–Femoral Bypass with Synthetic Graft

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

CPT 35606: Subclavian 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-35646-AORTO-FEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35646: Aorto-Femoral Bypass with Synthetic Graft

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

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

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

CPT 35600: Arterial Graft Harvest from Arm for Coronary Bypass

CPT-35650-AXILLARY-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35650: Axillary Artery Bypass with Synthetic Graft

CPT-35665-ILIAC-TO-FEMORAL-SYNTHETIC-GRAFT-BYPASS

CPT 35665: Iliac-to-Femoral Bypass with Synthetic Graft

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

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

CPT-35621-AXILLOFEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35621: Axillofemoral Bypass Using Synthetic Graft

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Taxonomy Code	Specialty	Notes
207K00000X	Vascular Surgery	Vascular surgeons commonly perform open aorto-mesenteric or aorto-renal bypasses.
2080P0207X	General Surgery	General surgeons with vascular expertise in centers without dedicated vascular surgery programs may perform this procedure.
207L00000X	Thoracic and Cardiovascular Surgery	Cardiothoracic/vascular surgeons may perform complex aortic bypass grafting involving visceral vessels.
2080S0170X	Transplant Surgery	Transplant surgeons occasionally involved when procedures are performed in complex abdominal reconstructions or combined operations.
207RP1001X	Interventional Cardiology (consultative)	Interventional specialists may be involved pre- or postoperatively for endovascular alternatives or hybrid approaches.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K55.0`	Acute vascular disorders of intestine	May present with acute mesenteric ischemia requiring urgent bypass when endovascular options are not feasible.
`K55.1`	Chronic vascular disorders of intestine	Classic indication for mesenteric revascularization such as aorto-mesenteric bypass to relieve chronic mesenteric ischemia.
`I70.2`	Atherosclerosis of native arteries of the extremities (unspecified site)	Reflects systemic atherosclerotic disease; atherosclerosis is the common underlying cause of visceral arterial occlusive disease.
`I72.3`	Aneurysm of visceral artery	May complicate or coexist with occlusive disease and influence graft planning or bypass strategy.
`N28.1`	Chronic or unspecified renal vascular disease	When renal artery occlusive disease is present, aorto-renal bypass with synthetic graft may be indicated.
`K76.9`	Liver disease, unspecified	Included as a potential comorbidity affecting perioperative risk assessment when addressing celiac axis disease.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35631`	Bypass, with synthetic graft, celiac, mesenteric, or renal artery; aorta to mesenteric/visceral artery	Primary open surgical procedure to bypass visceral arterial occlusive disease.
`34905`	Graft, bypass, aorto-iliac-femoral, with synthetic graft (separate code example of major aortic bypass procedures)	Performed in cases with concomitant aortoiliac disease or when planning more extensive aortic bypass; represents related major vascular grafting techniques.
`36147`	Introduction of catheter, other noncoronary vessel, for diagnostic angiography, radiological supervision and interpretation	Diagnostic angiography may be performed preoperatively or intraoperatively for vessel mapping or runoff assessment.
`36247`	Selective catheter placement, visceral artery, radiological supervision and interpretation	Used for preoperative or intraoperative selective mesenteric or renal angiography to define lesions.
`35800`	Endarterectomy, open, with or without patch graft, abdominal visceral arteries	Alternative or adjunctive open procedures for focal lesions of visceral arteries performed in the same operative setting in selected patients.
`99100`	Anesthesia complicated or emergency (qualifying circumstances)	Used when unusual circumstances require additional anesthesia services beyond routine care for the operative patient.

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