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    OpenPayerBilling CodesAdjuvant Techniques Procedures on Arteries and VeinsCPT cpt-35686-lower-extremity-arteriovenous-fistula-creation-during-bypass
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    CPT 35686: Creation of AV Fistula at/Beyond Lower Extremity Bypass

    Medicare pays $145 on average nationally for this procedure.

    CPT code 35686 describes surgical creation of an arteriovenous fistula (an abnormal connection between an artery and a vein) at or beyond a lower extremity bypass site performed concurrently with the bypass procedure; the service is a surgical vascular procedure typically performed in an operating room or vascular surgery suite as part of lower extremity revascularization.

    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 68-year-old male with peripheral arterial disease undergoing a lower extremity arterial bypass to revascularize a critically ischemic limb. During the bypass procedure the vascular surgeon creates an arteriovenous fistula at or distal to the bypass site to improve distal runoff and graft patency. The patient is taken to the operating room under general anesthesia. The vascular surgery team performs arterial exposure, harvests or prepares the bypass conduit, completes the bypass anastomoses, and then performs the simultaneous creation of an arteriovenous fistula between a suitable artery and adjacent vein in the lower extremity. Hemostasis is obtained, wounds closed, and the patient is recovered in the post-anesthesia care unit with vascular monitoring of graft and fistula flow.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    35686Creation of arteriovenous fistula at or beyond bypass site in lower extremity, performed at same time as bypassPrimary code describing creation of an AV fistula performed concurrently with lower extremity arterial bypass.
    35566Lower extremity arterial bypass, femoral to below-knee popliteal with vein graft (example)Common bypass procedure during which 35686 may be performed concurrently to improve runoff.
    35631Lower extremity arterial bypass, open; femoral to popliteal, single segment prosthetic or vein graftAnother bypass variant commonly performed before or with fistula creation to enhance outflow.
    35266Ligation, open, of arteriovenous fistula (hypothetical related procedure)Performed if later ligation of the fistula is required due to complications or high-output issues.
    93925Duplex scan of extremity arteries and veins (bilateral)Preoperative or postoperative vascular imaging to evaluate graft and fistula patency.

    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…
    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…
    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
    2080P0206X
    2080P0205X
    207R00000X
    2084P0800X
    2086S0122X
    207WX0108X
    103TF0200X
    364SP0200X

    Related ICD-10-CM Codes

    22 rows

    ICD-10-CM CodeDescription
    E11.51Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
    E78.5Hyperlipidemia, unspecified
    I70.213Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
    I70.219Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity
    I70.221Atherosclerosis of native arteries of extremities with rest pain, right leg
    I70.229Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity
    I70.233Atherosclerosis of native arteries of right leg with ulceration of ankle
    I70.234Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
    I70.235Atherosclerosis of native arteries of right leg with ulceration of other part of foot
    I70.241Atherosclerosis of native arteries of left leg with ulceration of thigh

    Showing 1–10 of 22

    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-35685-DISTAL-SYNTHETIC-PATCH-CUFF-FOR-BYPASS-GRAFT

    CPT 35685: Distal Synthetic Patch for Bypass Graft

    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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