CPT 35665 Iliac-to-Femoral Bypass Reimbursement | OpenPayer

Summary & Overview

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

CPT code 35665 identifies an open vascular surgical procedure in which a synthetic graft is used to bypass an occluded iliac artery to the femoral artery. This intervention is a key component of arterial revascularization for patients with significant aortoiliac occlusive disease and limb-threatening ischemia. Nationally, such bypass procedures remain important for restoring lower-extremity perfusion when endovascular options are unsuitable or have failed.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find clinical context for when an iliac-to-femoral synthetic graft bypass is used, expected sites of service, and the service line classification. The publication outlines commonly reported modifiers and identifies gaps where specific taxonomy and diagnosis code mappings are not provided in the input (Data not available in the input).

The report is designed to inform billing, clinical documentation, and policy stakeholders about the clinical role of CPT code 35665, typical care settings, and payer coverage considerations. It also highlights areas where additional coding detail or payer-specific policy information would be needed to support claims submission and authorization workflows.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35665iliac-femoral bypassarterial bypass surgeryvascular surgerysynthetic graftinpatient surgeryrevascularizationbilling guidance

Billing Code Overview

CPT code 35665 describes surgical bypass of an occluded or stenotic iliac artery using a synthetic graft to establish inflow to the femoral artery. The procedure reroutes blood flow around an iliac arterial blockage by creating a conduit from the iliac circulation to the femoral circulation using a prosthetic graft.

Service type: Arterial bypass surgery

Typical site of service: Operating room / Inpatient surgical setting, often performed in a hospital surgical suite with postoperative inpatient care for vascular surgery patients.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of peripheral arterial disease and smoking presents with progressive left lower extremity claudication and diminished distal pulses. Noninvasive vascular studies (ABI, arterial duplex) demonstrate a significant occlusive lesion of the left common iliac artery with reduced ankle-brachial index and evidence of tissue ischemia during exertion. The vascular surgeon schedules an open iliac-to-femoral bypass using a synthetic graft to reestablish inflow to the femoral artery and relieve ischemia.

Preoperative workflow includes vascular imaging (CT angiography or conventional angiography) to map the lesion and inflow/outflow vessels, medical optimization (antiplatelet therapy, statin management), informed consent discussing risks and benefits, and anesthesia evaluation. Intraoperatively, the surgeon exposes the iliac artery and common femoral artery, constructs proximal and distal anastomoses with a synthetic graft (typically Dacron or PTFE), verifies graft patency, and achieves hemostasis. Postoperative care involves vascular monitoring, limb perfusion checks, anticoagulation/antiplatelet management per protocol, wound care, and surveillance imaging as indicated. Typical sites of service are an inpatient hospital operating room or an ambulatory surgical center when clinically appropriate. The service type is surgical vascular bypass (open arterial revascularization).

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component

CPT 35600: Arterial Graft Harvest from Arm for Coronary Bypass

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

CPT 35638: Aorto to Bilateral Iliac Bypass with Synthetic Graft

CPT-35616-SUBCLAVIAN-TO-AXILLARY-BYPASS-SYNTHETIC-GRAFT

CPT 35616: Subclavian-to-Axillary Bypass with Synthetic Graft

CPT-35612-SUBCLAVIAN-ARTERY-BYPASS-SYNTHETIC-GRAFT

CPT 35612: Subclavian Artery Bypass with Synthetic Graft

CPT-35631-AORTO-VISCERAL-RENAL-BYPASS-SYNTHETIC-GRAFT

CPT 35631: Aortic-to-Visceral/Renal 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-35636-SPLENIC-TO-RENAL-ARTERY-BYPASS-SYNTHETIC-GRAFT

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

CPT-35621-AXILLOFEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35621: Axillofemoral Bypass Using Synthetic Graft

CPT-35663-ILIAC-ARTERY-CROSS-FEMORAL-BYPASS-SYNTHETIC-GRAFT

CPT 35663: Iliac Artery Cross-Femoral Bypass with Synthetic Graft

CPT-35654-AXILLARY-FEMORAL-BYPASS-NON-VEIN-GRAFT

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

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Taxonomy Code	Specialty	Notes
208100000X	Vascular Surgery	Primary specialty performing iliac-to-femoral bypass grafting.
207P00000X	General Surgery	General surgeons with vascular expertise may perform open arterial bypass procedures.
208000000X	Thoracic and Cardiovascular Surgery	Cardiothoracic/vascular surgeons involved in complex arterial reconstructions.
366A00000X	Physician Assistant	Common procedural support provider in vascular surgery teams.
364S00000X	Registered Nurse First Assistant	Frequently assists in open vascular procedures and closure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.2`	Atherosclerosis of native arteries of the extremities	Common underlying cause of iliac artery occlusive disease necessitating bypass.
`I70.213`	Atherosclerosis of native arteries of extremities with intermittent claudication, left leg	Typical presenting symptom prompting revascularization procedures such as iliac-femoral bypass.
`I70.241`	Atherosclerosis of bypass graft of the extremities, bilateral legs	Relevant when prior graft disease requires revision or new bypass planning.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Acute or chronic thromboembolic disease that may necessitate bypass if endovascular options are not suitable.
`I96`	Gangrene, not elsewhere classified	Severe ischemia complication that can necessitate revascularization to salvage limb.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35666`	Iliac-femoral/femoral-femoral bypass, with vein graft (includes harvesting)	Alternative conduit option when autogenous vein is used instead of synthetic graft; may be chosen based on conduit availability.
`35566`	Endarterectomy, iliac artery	Performed when plaque is amenable to endarterectomy rather than bypass; may be an alternative or adjunct in inflow restoration.
`36245`	Selective catheter placement, arterial system, initial branch (e.g., visceral, renal, or other)	Used for diagnostic angiography or preoperative catheter-based imaging to localize lesions prior to open bypass.
`75989`	Angiography, extremity(ies), bilateral, non-selective, radiological supervision and interpretation	Used for noninvasive or catheter-based angiographic imaging associated with preoperative planning or intraoperative angiography.
`36478`	Endovascular ablation, not applicable here (Data not used)	Data not available in the input.
`39220`	Drainage of postoperative hematoma, complicated (e.g., requiring return to OR)	Represents potential return-to-OR procedure for postoperative complications related to open vascular surgery.

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