Summary & Overview
CPT 35663: Iliac Artery Cross-Femoral Bypass with Synthetic Graft
CPT code 35663 denotes a synthetic-graft arterial bypass that reroutes blood from one iliac artery to the contralateral iliac artery to bypass an occlusion. This vascular surgical procedure is an established option for restoring lower-extremity perfusion when endovascular approaches are unsuitable or have failed. It is clinically significant because it addresses critical limb ischemia and symptomatic peripheral arterial disease, conditions with substantial morbidity and cost implications across the U.S.
Key national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 35663, the typical sites of service, and the service type. The publication summarizes how this procedure is positioned within surgical vascular care and highlights the types of benchmarks and policy topics that matter to hospitals and clinicians, including coding specificity, inpatient surgical resource utilization, and payer coverage considerations. Data not available in the input is noted where applicable.
This summary is intended to orient clinical, billing, and policy audiences to the code’s purpose, common care setting, and where to look for payer-specific coverage and reimbursement details.
Billing Code Overview
CPT code 35663 describes a surgical bypass using a synthetic graft to reroute blood flow from one iliac artery to the opposite iliac artery, bypassing an occlusion. The procedure creates a cross-femoral or cross-iliac arterial bypass to restore lower-extremity perfusion when one iliac artery is blocked.
Service Type: Vascular surgical bypass procedure
Typical Site of Service: Hospital operating room or inpatient surgical setting, with perioperative and possible postoperative inpatient care.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old male with progressive left lower-extremity claudication and decreased ankle-brachial index after conservative therapy. Noninvasive vascular testing and CT angiography confirm a high-grade left common iliac artery occlusion with inadequate distal flow and a patent contralateral iliac system. The vascular surgery team schedules an open arterial bypass using a synthetic graft to reroute blood from the right common iliac artery to the left common iliac artery, restoring inflow to the affected limb.
Preoperative workflow includes vascular imaging review, medical optimization (antiplatelet and statin therapy as indicated), informed consent addressing graft type and limb ischemia risks, anesthesia evaluation (general or regional), and surgical site preparation. Intraoperative steps include exposure of the bilateral iliac arteries, heparinization, tunneling of a synthetic graft (e.g., Dacron or PTFE) through the retroperitoneum or extraperitoneal corridor, proximal and distal anastomoses, graft patency confirmation (doppler signals/angiography), and hemostasis. Postoperative care focuses on limb perfusion monitoring, graft surveillance, anticoagulation/antiplatelet management per protocol, wound care, and discharge planning with vascular follow-up and duplex surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified | Rarely used; apply only if required by payer when no other modifier fits |