Summary & Overview
CPT 35650: Axillary Artery Bypass with Synthetic Graft
CPT code 35650 represents a vascular surgical procedure in which a synthetic graft is used to bypass an occlusion of the axillary artery. This operation restores blood flow to the upper extremity when arterial blockage cannot be managed with endovascular techniques or when open bypass is clinically indicated. Nationally, procedures of this type impact hospital vascular surgery service lines and contribute to utilization patterns for complex peripheral arterial disease management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, expected sites of care, and typical service classification. The publication summarizes benchmarks and reimbursement considerations relevant to hospital-based vascular surgery, highlights documentation and coding points that affect claim submission, and outlines policy updates that influence coverage and payment pathways. Where specific payer policy details or utilization metrics are not provided in the input, the report notes: Data not available in the input.
This summary equips clinical coding staff, revenue cycle managers, and policy analysts with a clear, national-level brief on CPT code 35650, its clinical role in treating axillary artery occlusion, and the payer landscape typically involved in reimbursement and authorization workflows.
Billing Code Overview
CPT code 35650 describes a surgical bypass of an occluded segment of the axillary artery using a synthetic vascular graft. The procedure reroutes blood flow around a blockage in the axillary artery, which is a continuation of the subclavian artery, to restore perfusion to the upper extremity.
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Service type: Vascular surgical bypass using a synthetic graft
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Typical site of service: Hospital operating room or inpatient vascular surgery unit
Clinical & Coding Specifications
Clinical Context
A typical patient is an older adult with symptomatic upper-extremity ischemia due to atherosclerotic occlusion of the axillary artery. The patient presents with progressive arm claudication, rest pain, diminished distal pulses, and nonhealing hand ischemic ulcers despite conservative therapy. Preoperative evaluation includes arterial duplex ultrasound and CT angiography confirming focal axillary arterial occlusion and suitability for a bypass. The vascular surgery team performs an axillary artery bypass using a synthetic prosthetic graft to reestablish inflow to the brachial artery, typically in an operating room under general or regional anesthesia. Intraoperative steps include proximal and distal arterial exposure, systemic heparinization, proximal and distal control, arteriotomy creation, graft selection and tunneling, end-to-side anastomoses, restoration of flow with completion angiography or duplex as indicated, and wound closure. Postoperative care includes monitoring vascular perfusion, anticoagulation or antiplatelet therapy per protocol, serial vascular examinations, and surveillance duplex imaging during follow-up. Typical site of service is an acute care hospital operating room; ambulatory surgical center use is uncommon for this major open vascular procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Routine reporting when no modifier applies |