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    v1.0.30
    OpenPayerBilling CodesAdjuvant Techniques Procedures on Arteries and VeinsCPT cpt-35685-distal-synthetic-patch-cuff-for-bypass-graft
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    CPT 35685: Distal Synthetic Patch for Bypass Graft

    Medicare pays $178 on average nationally for this procedure.

    CPT code 35685 describes an add-on vascular surgery procedure in which the surgeon places a synthetic patch or cuff at the distal site of a synthetic bypass graft at the time of graft placement to improve conduit quality and patency at the distal bypass anastomosis; service type: surgical add-on vascular procedure; typical site of service: operating room or surgical suite during a vascular bypass operation.

    For related coverage guidance, see recent payer policy updates: Positron Emission Tomography (PET) - Non-Oncologic Applications, Positron Emission Tomography (PET) Oncologic Applications, Magnetic Resonance Imaging (MRI) of the Prostate.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an older adult with symptomatic peripheral arterial disease undergoing lower extremity arterial bypass for critical limb ischemia or lifestyle-limiting claudication. The vascular surgeon, often in an operating room or hybrid endovascular suite, performs placement of a synthetic bypass graft (for example, femoropopliteal or femorodistal bypass). At the time of graft placement, the surgeon performs the add-on procedure to place a synthetic patch or cuff at the distal anastomosis to improve distal conduit geometry and patency. The workflow includes preoperative assessment with arterial imaging (duplex ultrasound, CT angiography or digital subtraction angiography), intraoperative anticoagulation and heparinization, exposure of the target artery, creation of the distal anastomosis, placement and fixation of the synthetic patch or cuff, hemostasis, and postoperative monitoring in the post-anesthesia care unit with vascular checks and anticoagulation management as indicated.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    35566Endarterectomy, femoral artery, with patch graftMay be performed proximal or in combination when native artery disease requires endarterectomy and patching during limb revascularization.
    35656Bypass graft, with vein; femoral-popliteal, above knee, single segmentAlternative conduit choice; performed when autogenous vein bypass is used instead of synthetic graft.
    35666Bypass graft, with other than vein; femoral-popliteal, above knee, using prosthetic materialCore bypass graft codes describing placement of a synthetic graft to which the distal patch/cuff (35685) is added.
    35820Insertion of intravascular stent(s), open or percutaneous, lower extremity, with angioplasty when performed; initial vesselMay be performed in hybrid procedures addressing inflow or outflow lesions in conjunction with bypass and cuff placement.
    36011Introduction of needle or catheter, including imaging guidance; for diagnostic angiography or conduit accessUsed for intraoperative angiography or access to guide distal anastomosis assessment or completion angiogram.

    Related Modifiers

    7 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…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    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…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207RH0000X
    363LF0000X
    208000000X
    2255R0406X
    2080C0008X
    332900000X
    1041C0700X

    Related Payer Policy Updates

    Specialty: Radiology/Diagnostic Imaging1 / 2

    10 rows

    PolicyPayerEffective Date
    Positron Emission Tomography (PET) - Non-Oncologic Applicationsuniverahealthcare2026-10-15
    Positron Emission Tomography (PET) Oncologic Applicationsuniverahealthcare2026-10-15
    Magnetic Resonance Imaging (MRI) of the Prostateuniverahealthcare2026-10-15
    Diagnostic and Therapeutic Radiology ServicesUnitedHealthcare2026-10-01
    Diagnostic Dynamic Spinal Visualization and Vertebral Motion Analysis (for Nebraska Only)UnitedHealthcare2026-10-01
    Diagnostic Dynamic Spinal Visualization and Vertebral Motion Analysis (for New Mexico Only)UnitedHealthcare2026-10-01
    Diagnostic Dynamic Spinal Visualization and Vertebral Motion AnalysisUnitedHealthcare2026-10-01
    Diagnostic Dynamic Spinal Visualization and Vertebral Motion Analysis (for North Carolina Only)UnitedHealthcare2026-10-01
    Diagnostic Dynamic Spinal Visualization and Vertebral Motion Analysis (for Kentucky Only)UnitedHealthcare2026-10-01
    Diagnostic Dynamic Spinal Visualization and Vertebral Motion Analysis (for Kansas Only)UnitedHealthcare2026-10-01

    Related Codes

    CPT-35686-LOWER-EXTREMITY-ARTERIOVENOUS-FISTULA-CREATION-DURING-BYPASS

    CPT 35686: Creation of AV Fistula at/Beyond Lower Extremity 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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