CPT 35656 Femoral-to-Popliteal Bypass Reimbursement | OpenPayer

Summary & Overview

CPT 35656: Femoral-to-Popliteal Bypass with Synthetic Graft

CPT code 35656 represents a peripheral arterial bypass using a synthetic graft to reroute blood flow from the femoral artery to the popliteal artery around an occlusion. This open vascular surgery is a key intervention for patients with significant femoropopliteal arterial disease and limb ischemia when endovascular options are inadequate or unsuitable. Nationally, the code is relevant because it aligns with care pathways for limb salvage and chronic peripheral arterial disease management and factors into hospital surgical case mix and vascular surgery quality reporting.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for the procedure, common sites of service, and typical service type. The publication outlines payer coverage considerations and common billing modifiers where available, and it highlights areas readers should review for policy updates, documentation expectations, and reimbursement variability across major payers. Data not available in the input is noted where applicable. The content is intended to support coding accuracy, administrative planning, and payer policy review at a national level.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35656peripheral arterial bypassvascular surgeryfemoropopliteal bypasssynthetic graftsurgical procedurehospital serviceslimb ischemia

Billing Code Overview

CPT code 35656 describes a surgical bypass procedure in which a synthetic graft is used to reroute blood flow around an occlusion in the femoral artery to the popliteal artery. The goal of the procedure is to restore arterial inflow to the lower extremity distal to a blockage.

Service type: Peripheral arterial bypass using synthetic graft

Typical site of service: Hospital operating room or inpatient surgical unit, with possible performance in an ambulatory surgery center when clinically appropriate.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a long history of peripheral arterial disease (PAD), progressive lifestyle-limiting claudication of the right lower extremity, and an occlusive lesion of the superficial femoral artery presents after noninvasive vascular studies and angiography confirm a high-grade femoral artery occlusion with inadequate runoff to the distal tibial vessels. Conservative therapy including smoking cessation, exercise therapy, and pharmacotherapy failed to relieve symptoms. The vascular surgery team schedules an open femoro-popliteal bypass using a synthetic prosthetic graft to re-establish inflow to the popliteal artery distal to the occlusion.

Preoperative workflow includes history and physical, cardiac risk assessment, duplex ultrasound and/or CT angiography to map inflow and outflow vessels, informed consent specifying use of a synthetic conduit, and perioperative medication management. Intraoperative steps include exposure of the common femoral and popliteal arteries, systemic heparinization, proximal and distal anastomoses of the synthetic graft (bypass from femoral to popliteal), verification of graft patency via Doppler or completion angiography, and wound closure. Postoperative care includes limb perfusion monitoring, antiplatelet therapy, graft surveillance with duplex ultrasound, and wound care. Typical site of service is an inpatient or outpatient hospital operating room or an ambulatory surgical center when appropriate for patient risk.

Coding Specifications

Modifier	Description	When to Use
`00`

CPT 35642: Carotid-to-Vertebral Artery Bypass with Synthetic Graft

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

CPT 35601: Common Carotid Artery Bypass with Synthetic Graft

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

CPT 35632: Iliac-to-Celiac Synthetic Graft Bypass

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

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

CPT-35621-AXILLOFEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35621: Axillofemoral Bypass Using Synthetic Graft

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

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

CPT-35623-AXILLARY-TO-POPLITEAL-OR-TIBIAL-BYPASS-SYNTHETIC-GRAFT

CPT 35623: Axillary-to-Popliteal/Tibial 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-35647-AORTO-FEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35647: Aorto-Femoral Bypass with Synthetic Graft

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

CPT 35638: Aorto to Bilateral Iliac Bypass with Synthetic Graft

Showing 1–10 of 27

Taxonomy Code	Specialty	Notes
207P00000X	Vascular Surgery	Primary specialty performing femoro-popliteal bypass procedures
2080P0206X	General Surgery	Many general surgeons with vascular training perform peripheral bypass procedures
207R00000X	Interventional Cardiology / Endovascular Surgery	Performs diagnostic and endovascular adjuncts; may collaborate with open bypass teams
2086S0123X	Thoracic and Cardiovascular Surgery	Vascular surgeons with cardiothoracic training who may perform complex peripheral bypasses
207K00000X	Surgery - Cardiovascular	Alternate taxonomy for surgeons performing peripheral vascular reconstruction

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.201`	Atherosclerosis of native arteries of extremities, right leg, with intermittent claudication	Common indication for femoro-popliteal bypass when lifestyle-limiting claudication persists despite conservative therapy
`I70.202`	Atherosclerosis of native arteries of extremities, left leg, with intermittent claudication	Same as above for left-sided disease
`I70.21`	Atherosclerosis of native arteries of extremities with rest pain	Indicates more severe ischemia prompting revascularization such as bypass
`I70.22`	Atherosclerosis of native arteries of extremities with ulceration	Tissue loss or ulceration may necessitate bypass to improve limb perfusion and wound healing
`I70.23`	Atherosclerosis of native arteries of extremities with gangrene	Severe ischemia with gangrene often requires urgent revascularization or amputation; bypass is a limb-salvage option
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute arterial occlusion that may require embolectomy or bypass depending on chronicity and vessel condition
`I73.9`	Peripheral vascular disease, unspecified	General diagnosis often used in conjunction with more specific PAD codes during evaluation and management

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36820`	Arterial embolectomy or thrombectomy, with or without catheter; iliac, femoral, or popliteal	Performed when acute thromboembolism is present and may be used before or instead of bypass if embolus removal is feasible
`35666`	Extra-anatomic bypass, prosthetic, femoral to popliteal, above-knee	Alternate code for femoro-popliteal bypass to the above-knee popliteal target; closely related when graft target differs
`35566`	Revascularization, bypass graft, with other specified sites (note: used for arterial bypass procedures)	May describe similar or adjunctive bypass procedures depending on anatomic specifics (verify code applicability)
`36147`	Introduction of needle or catheter into vessel for diagnostic angiography, lower extremity (including transluminal angioplasty)	Diagnostic angiography or catheter-based interventions often performed preoperatively or intraoperatively as adjuncts to surgical bypass
`93975`	Duplex scan of arterial inflow and outflow, bilateral study	Noninvasive vascular testing used pre- and postoperatively for mapping and surveillance of bypass graft patency

OpenPayer