CPT 35654 Axillary‑Femoral Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35654: Axillary to Femoral Bypass Using Non-Vein Graft

CPT code 35654 represents an open vascular bypass procedure that uses a graft other than a vein to reroute circulation from the axillary artery to the femoral arteries, bypassing blockages in the lower aorta or major abdominal arteries. The code captures a complex extra-anatomic revascularization technique used when direct aortoiliac repair is impractical or contraindicated. Nationally, this procedure is significant for vascular surgery practice patterns, resource intensity, and high-acuity inpatient care.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, plus the types of benchmarks and policy considerations commonly associated with major vascular reconstructive services: utilization metrics, site-of-service patterns, payer coverage nuances, and procedural coding guidance. The publication also outlines expected locations of care—typically hospital operating rooms staffed by vascular surgery teams—and summarizes what stakeholders can expect in terms of reporting and billing complexity for this category of open bypass surgery.

Data not available in the input for specific ICD-10 diagnoses, associated taxonomies, related codes, and payer-specific reimbursement rates.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35654axillofemoral bypassvascular surgeryopen bypassnon-vein graftaortoiliac diseaseinpatient surgerysurgical coding

Billing Code Overview

CPT code 35654 describes a surgical bypass using a graft other than a vein to reroute blood flow around a blockage in the lower aorta or the major abdominal arteries by creating a connection from the axillary artery to the femoral arteries. This procedure is a form of extra-anatomic bypass intended to restore lower-extremity or pelvic perfusion when direct aortic or iliac reconstruction is not feasible.

Service type: Open vascular surgical bypass using a non-vein graft
Typical site of service: Hospital operating room, often within vascular surgery or tertiary surgical centers

Clinical & Coding Specifications

Clinical Context

A 72-year-old male with a history of peripheral arterial disease and severe aortoiliac occlusive disease presents with lifestyle-limiting claudication and rest pain in both lower extremities. Noninvasive vascular testing (ankle-brachial index, arterial duplex) and CT angiography demonstrate extensive occlusive disease of the infrarenal abdominal aorta and common iliac arteries not amenable to endovascular repair. The vascular surgery team elects to perform an axillofemoral bypass using a prosthetic graft (graft other than a vein) to re-establish inflow to bilateral femoral arteries. The procedure is performed in an operating room under general anesthesia with intraoperative heparinization, graft tunneling, proximal anastomosis to the axillary artery, and distal anastomoses to one or both femoral arteries.

Preoperative workflow includes vascular surgery consult, medical clearance, informed consent with discussion of risks (bleeding, infection, graft thrombosis), and documentation of indications. Intraoperative documentation must detail artery used for inflow, graft type and size, tunneling route, anastomotic sites, clamps times, estimated blood loss, and any intraoperative complications. Postoperative workflow includes vascular monitoring, anticoagulation management, wound care, and documentation of neurologic or limb perfusion outcomes. Billing is reported with 35654 for axillary–femoral bypass using a graft other than a vein.

Coding Specifications

Modifier	Description	When to Use
`26`

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

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

CPT 35606: Subclavian Artery Bypass with Synthetic Graft

CPT-35671-POPLITEAL-TO-TIBIAL-PERONEAL-BYPASS-SYNTHETIC-GRAFT

CPT 35671: Popliteal to Tibial/Peroneal Bypass with Synthetic Graft

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

CPT 35601: Common Carotid Artery Bypass with Synthetic Graft

CPT-35638-AORTO-BILATERAL-ILIAC-BYPASS-SYNTHETIC-GRAFT

CPT 35638: Aorto to Bilateral Iliac Bypass with Synthetic Graft

CPT-35666-FEMORAL-TO-TIBIAL-OR-PERONEAL-BYPASS-SYNTHETIC-GRAFT

CPT 35666: Femoral-to-Tibial/Peroneal Bypass with Synthetic Graft

CPT-35621-AXILLOFEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35621: Axillofemoral Bypass Using Synthetic Graft

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

CPT 35650: Axillary Artery Bypass with Synthetic Graft

CPT-35633-ILIAC-TO-MESENTERIC-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35633: Iliac-to-Mesenteric Artery Bypass with Synthetic Graft

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

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

Showing 1–10 of 27

Taxonomy Code	Specialty	Notes
`208000000X`	Vascular Surgery	Primary specialty performing axillofemoral bypass procedures.
`2080P0208X`	Cardiothoracic-Vascular Surgery	Surgeons with combined training who may perform complex aortoiliac bypasses.
`207RC0000X`	General Surgery	General surgeons with vascular practice who may perform peripheral bypass when vascular surgeons are unavailable.
`207K00000X`	Thoracic Surgery	May be involved when axillary inflow or upper chest exposure is required.
`363L00000X`	Interventional Cardiology	Typically not primary for open surgical bypass but may be involved in pre/post endovascular procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.2`	Atherosclerosis of native arteries of the extremities	Common underlying disease causing aortoiliac occlusion requiring bypass.
`I70.201`	Atherosclerosis of native arteries of the extremities, with intermittent claudication, right leg	Intermittent claudication may prompt bypass when lifestyle-limiting and anatomically unsuitable for endovascular repair.
`I70.202`	Atherosclerosis of native arteries of the extremities, with intermittent claudication, left leg	Same clinical relevance for left-sided symptoms.
`I70.211`	Atherosclerosis of native arteries of the extremities with rest pain, right leg	Rest pain indicates critical limb ischemia and is an indication for surgical revascularization.
`I70.212`	Atherosclerosis of native arteries of the extremities with rest pain, left leg	Same clinical relevance for left-sided rest pain.
`I70.23`	Atherosclerosis of native arteries of the extremities with ulceration	Tissue loss or ulceration may necessitate revascularization via axillofemoral bypass.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute or chronic thrombotic disease may be an indication for bypass if endovascular therapy is not feasible.
`I65.2`	Occlusion and stenosis of carotid artery	Not directly treated with axillofemoral bypass but listed when multi-vascular disease is present; include only if clinically documented.

Note: Use the most specific laterality and manifestation codes supported by documentation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35654`	Axillary-femoral bypass, utilizing graft other than vein, to femoral artery(ies)	Primary procedure to bypass aortoiliac occlusive disease when endovascular or aortobifemoral grafting is not feasible.
`36247`	Selective catheter placement, arterial conduit, axillary or brachial approach	May be performed preoperatively or intraoperatively for angiography or selective imaging of the axillary inflow.
`36215`	Arterial catheterization for diagnostic angiography, percutaneous, initial vessel	Often used for diagnostic lower extremity angiography prior to open bypass when endovascular options are considered.
`35566`	Extra-anatomic bypass graft, axillofemoral, with prosthetic graft, unilateral	Related extra-anatomic grafting codes may be reported depending on laterality and technique; documents variant approaches.
`35831`	Aorto-bifemoral bypass, with prosthetic graft	Alternative definitive open repair for aortoiliac occlusive disease; represents a different surgical option in the treatment algorithm.

Note: Use 35654 for axillofemoral bypass with a nonvein graft. Other codes listed are commonly associated diagnostic or alternative repair codes encountered in the clinical workflow.

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