Summary & Overview
CPT 35661: Femoral–Femoral Bypass with Synthetic Graft
CPT code 35661 represents a femoral–femoral bypass using a synthetic graft to reroute blood flow around a femoral artery occlusion. This vascular surgical procedure is clinically important for limb salvage and symptom relief in patients with peripheral arterial disease when endovascular options are unsuitable or have failed. Nationally, reimbursement and coding clarity for such bypass procedures affect hospital surgical departments, vascular surgery practices, and payer medical policy development.
Key payers commonly involved in coverage and payment discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers of this publication will find a concise overview of clinical context and typical sites of service, plus benchmarking information where available. The report outlines common payer coverage considerations, prevalent modifier usage patterns, and how CPT code 35661 aligns with related vascular procedures.
This analysis provides clinicians, coding professionals, and policy analysts with the information needed to understand the purpose of the code, expected care settings, and the payer landscape relevant to reimbursement and utilization. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 35661 describes a surgical bypass procedure using a synthetic graft to reroute blood flow around an occlusion in the femoral artery by connecting to the femoral artery in the opposite leg. This procedure is a form of peripheral vascular bypass intended to restore perfusion to the affected limb when native arterial flow is blocked.
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Service type: Surgical peripheral arterial bypass using a synthetic graft
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Typical site of service: Inpatient or outpatient hospital surgical setting, typically performed in an operating room
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with progressive right lower-extremity claudication, rest pain, and nonhealing ischemic ulceration of the forefoot presents for vascular surgical evaluation. Noninvasive testing (ankle-brachial index 0.4) and diagnostic angiography confirm an occlusive lesion of the right common femoral or superficial femoral artery not amenable to endovascular therapy. The vascular surgeon plans an extra-anatomic femoral–femoral bypass using a synthetic prosthetic graft to re-establish inflow to the ischemic limb by routing blood from the contralateral (left) femoral artery to the right femoral artery.
Preoperative workflow includes history and physical, vascular imaging review, perioperative cardiopulmonary risk assessment, and anticoagulation management. Intraoperative steps include exposure of bilateral femoral arteries, tunneling the synthetic graft subcutaneously across the suprapubic region, anastomosis to the donor and recipient femoral arteries, hemostasis, and surgical wound closure. Postoperative care involves limb perfusion monitoring, wound care, anticoagulation/antiplatelet therapy adjustment, and surveillance duplex ultrasound before discharge and at follow-up visits.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no modifier applies |
11 | Primary procedure | When this femoral–femoral bypass is the primary service for the encounter |
22 | Increased procedural services | When work or complexity substantially exceeds typical for 35661 (document justification) |
52 | Reduced services | When the procedure is partially discontinued or not completed as planned |
53 | Discontinued procedure | When the procedure is terminated due to extenuating circumstances prior to completion |
62 | Two surgeons | When two surgeons of different specialties perform distinct portions of the operation concurrently |
62 | Note: 62 repeated in raw data but only listed once here to avoid duplication | |
66 | Surgical team (multiple surgeons) | When a documented surgical team approach is used for major vascular reconstruction |
78 | Unplanned return to the operating room | For same-day or inpatient return to OR for a related complication |
50 | Bilateral procedure | If bilateral femoral–femoral bypass techniques are reported (rare for this code) |
LT | Left side | To designate left-sided laterality when applicable |
RT | Right side | To designate right-sided laterality when applicable |
26 | Professional component | When separate reporting of physician professional component is required (rare for operative codes) |
QK | Medical direction of two to four CRNAs | When the surgeon directs anesthesia team as defined by CMS |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207P00000X | Vascular Surgery | Primary specialty performing open femoral–femoral bypass procedures |
| 207L00000X | General Surgery | Common when vascular surgeons are not available; general surgeons with vascular training perform procedure |
| 207R00000X | Cardiothoracic & Vascular Surgery | Performs complex peripheral bypass in some centers |
| 207K00000X | Plastic Surgery | Occasionally involved for complex soft-tissue management or wound coverage |
| 208600000X | Surgery Assistant | Surgical assistants (PAs/NPs/CSAs) frequently assist intraoperatively |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I70.213 | Atherosclerosis of native arteries of right leg with rest pain | Common indication when atherosclerotic occlusive disease causes critical limb ischemia of the right leg |
I70.214 | Atherosclerosis of native arteries of left leg with rest pain | Indication when contralateral inflow disease requires bypass from the opposite limb |
I70.201 | Atherosclerosis of native arteries of right leg with intermittent claudication | Typical symptom prompting revascularization when severe and lifestyle-limiting |
I70.202 | Atherosclerosis of native arteries of left leg with intermittent claudication | May represent donor limb disease evaluation and planning |
I70.23 | Atherosclerosis of bypass graft of the extremities, with rest pain | Relevant for patients with failing prior grafts considered for revision or new bypass |
I74.3 | Embolism and thrombosis of arteries of lower extremities | Acute limb ischemia may necessitate bypass if thromboembolectomy or endovascular therapy is inadequate |
I96 | Gangrene, not elsewhere classified | Severe ischemic tissue loss that can be an indication for revascularization to attempt limb salvage |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
35661 | Contralateral femoral-femoral bypass with synthetic graft | Primary procedure: creation of a synthetic graft bypass from one femoral artery to the contralateral femoral artery |
35566 | Thromboendarterectomy, femoral artery; with patch graft | May be performed adjunctively if ipsilateral femoral endarterectomy is required to optimize outflow |
35476 | Extra-anatomic bypass, axillofemoral or axillobifemoral, with synthetic graft | Alternative extra-anatomic bypass option when femoral–femoral bypass is not suitable |
75962 | Angioplasty, peripheral; transluminal, percutaneous, iliac, unilateral, initial vessel | Diagnostic/therapeutic peripheral endovascular procedures often performed prior to or in lieu of open bypass |
93925 | Duplex scan of arterial inflow and outflow extremity arteries | Noninvasive vascular testing used preoperatively and postoperatively for surveillance of graft patency |