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    v1.0.30
    OpenPayerBilling CodesComposite Graft Procedures on Arteries and VeinsCPT cpt-35681-composite-vein-synthetic-bypass-graft
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    CPT 35681: Composite Vein and Synthetic Bypass Graft

    Medicare pays $72 on average nationally for this procedure.

    CPT code 35681 describes an add‑on vascular surgical procedure to create a composite graft (conduit) composed of two different graft materials, typically autologous vein and synthetic graft, used as a bypass conduit; this is a bypass graft construction service performed in an operating room or surgical suite during vascular surgery to reestablish arterial blood flow around an occluded or diseased segment.

    For related coverage guidance, see recent payer policy updates: Umbilical Cord Blood Harvesting and Storage for Future Use (for North Carolina Only), Lantidra (donislecel): Allogeneic Pancreatic Islet Cellular Therapy, Autologous Stem Cell Transplantation Clinical Coverage Criteria.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an older adult with peripheral arterial disease (PAD) and multilevel lower extremity occlusive disease who presents with rest pain or nonhealing ischemic ulcers of the foot. Noninvasive vascular testing (arterial duplex ultrasound, ABI/TBI, and possibly CT angiography) demonstrates an inflow artery suitable for bypass but inadequate distal conduit or poor-quality continuous autogenous vein for a single-segment graft. The vascular surgeon elects to perform a lower extremity bypass using a composite graft created from a segment of autogenous vein joined to a segment of prosthetic conduit to span the diseased arterial segment and achieve distal perfusion.

    Clinical workflow: The patient undergoes preoperative assessment including history, focused vascular exam, and imaging. In the operating room under regional or general anesthesia, the surgeon harvests available autogenous vein (eg, short segment of greater saphenous vein). A prosthetic graft (eg, expanded polytetrafluoroethylene) is measured and anastomosed to the vein segment to create a composite conduit. Standard bypass inflow and outflow anastomoses are performed to revascularize the limb. Postoperative care includes limb perfusion monitoring, anticoagulation/antiplatelet therapy as indicated, wound care, and surveillance duplex studies to assess graft patency.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    35681Creation of composite graft (vein and synthetic) for bypass graft — add-on procedurePrimary procedure to describe construction of a composite conduit; billed in conjunction with the primary bypass code
    35566Bypass above-knee femoropopliteal with vein graft, open; single segmentAlternative when a single-segment autogenous vein conduit is used instead of a composite graft
    35563Bypass above-knee femoropopliteal with synthetic graft, openUsed when a fully synthetic graft is used for femoropopliteal bypass rather than a composite conduit
    35476Bypass, femoropopliteal, tibial/popliteal, single segment, with autogenous veinRelated bypass codes for infrainguinal reconstructions that may require composite conduits when vein is insufficient
    35800Revision; graft (arterial, venous)Used when postoperative graft revision or repair is required for the composite conduit
    33210Insertion of epicardial pacemaker (example of unrelated OR code)May appear on the same operative day in patients with multiple surgical needs but is unrelated to composite graft creation

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207K00000X
    2080P0207X
    207RG0300X
    2084P0800X
    363A00000X
    163WG0100X
    1835C0207X
    224900000X

    Related Payer Policy Updates

    Specialty: Transplant1 / 2

    10 rows

    PolicyPayerEffective Date
    Umbilical Cord Blood Harvesting and Storage for Future Use (for North Carolina Only)UnitedHealthcare2026-10-01
    Lantidra (donislecel): Allogeneic Pancreatic Islet Cellular TherapyAmbetter Georgia2026-10-01
    Autologous Stem Cell Transplantation Clinical Coverage Criteriafallon_community_health_plan_inc2026-09-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Pennsylvania Only)UnitedHealthcare2026-09-01
    Omisirge (omidubicel-onlv)Mass General Brigham Health Plan2026-09-01
    Hematopoietic Cell Transplantation for Autoimmune DiseasesBluecross Idaho2026-09-01
    Stem Cell Transplantation: Blood CancersCigna2026-08-15
    Thymus Tissue TransplantationCigna2026-08-15
    Hand and arm transplantsAmeriHealth Caritas2026-08-01
    Hematopoietic Cell Transplantation for Autoimmune DiseasesPremera Bluecross2026-08-01

    Related Codes

    CPT-35682-COMPOSITE-VEIN-CONDUIT-CREATION-BYPASS-GRAFT

    CPT 35682: Composite Vein Conduit for Vascular Bypass

    CPT-35683-COMPOSITE-VEIN-GRAFT-CONSTRUCTION-BYPASS

    CPT 35683: Composite Vein Graft for Arterial Bypass

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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