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CPT 35693: Vertebral-to-Subclavian Artery Bypass

CPT code 35693 represents an open vascular surgical procedure in which the vertebral artery is fully exposed, divided, and anastomosed to the subclavian artery to bypass an area of arterial blockage and restore arterial blood flow. Nationally, this code denotes a high-complexity, operative revascularization procedure typically performed by vascular or neurosurgical teams to address vertebrobasilar ischemia or proximal arterial occlusion. The code matters because it captures resource-intensive operating room care, specialized surgical technique, and postoperative monitoring needs.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and which payers commonly process claims for this service. The publication summarizes reimbursement and billing benchmarks where available, common modifier usage patterns, and implications for coding accuracy and documentation. It also highlights clinical indications and the role of this bypass in restoring cerebral perfusion. Data not available in the input are noted where applicable.

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Billing Code Overview

CPT code 35693 describes a surgical arterial bypass in which the provider fully exposes the vertebral artery, divides it, and anastomoses it to the subclavian artery to bypass an area of arterial blockage and improve blood flow. The procedure is a form of arterial revascularization aimed at restoring adequate cerebral or vertebrobasilar circulation when native arterial segments are obstructed.

Service type: Open vascular surgical revascularization of the vertebral artery
Typical site of service: Hospital operating room or specialized surgical suite for vascular surgery

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CPT 35693: Vertebral-to-Subclavian Artery Bypass

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Billing Code Overview

Service type: Open vascular surgical revascularization of the vertebral artery
Typical site of service: Hospital operating room or specialized surgical suite for vascular surgery

Clinical & Coding Specifications

Clinical Context

A typical patient is a 65-year-old male with symptomatic vertebrobasilar insufficiency due to proximal vertebral artery occlusive disease. The patient presents with recurrent transient ischemic attacks characterized by vertigo, diplopia, and ataxia despite optimal medical therapy (antiplatelet agents and risk-factor control). Diagnostic workup includes duplex ultrasonography, CT angiography or MR angiography demonstrating high-grade stenosis or occlusion of the vertebral artery near its origin, and digital subtraction angiography confirming anatomic suitability. After multidisciplinary vascular and neurosurgical review, the patient is scheduled for surgical revascularization.

The clinical workflow includes preoperative medical optimization and imaging, informed consent discussing risks (stroke, cranial nerve injury, bleeding), and coordination with anesthesia for general endotracheal anesthesia. In the operating room, the vascular or neurosurgical team exposes the vertebral artery, divides it, and performs an anastomosis to the subclavian artery (bypass) to circumvent the area of obstruction and restore posterior circulation flow. Intraoperative neurophysiologic monitoring and completion angiography may be used to confirm patency. Postoperative care involves ICU or step-down monitoring for neurologic changes, blood pressure management, and antithrombotic therapy as indicated.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal (usual) postoperative recovery	Use when the procedure has a typical, uncomplicated postoperative course.
`22`	Increased procedural services	Use when substantial additional work is documented beyond typical for the procedure (e.g., extensive dissection or complex revision).
`52`	Reduced services	Use when the service performed is less than described by the CPT code (e.g., procedure started but aborted before completion).
`53`	Discontinued procedure	Use when the procedure is terminated due to extenuating circumstances or safety concerns prior to completion.
`62`	Two surgeons	Use when co-surgeons of different specialties are required and documented.
`66`	Surgical team approach	Use when a surgical team (multiple surgeons with distinct roles) is documented.
`78`	Unplanned return to the operating room	Use when the patient returns to the OR for a related procedure during the postoperative global period.
`80`	Assistant surgeon	Use when an assistant surgeon performs documented assistance during the procedure.
`81`	Minimum assistant surgeon	Use when only minimal assistant participation is documented.
`82`	Assistant surgeon (when qualified resident not available)	Use when a qualified resident is not available and an assistant is required.
`26`	Professional component	Use if billing an interpretation or professional component separate from technical services (rare for this operative code).
`50`	Bilateral procedure	Use if the surgical procedure is performed bilaterally and a bilateral modifier is required by payer policy.
`53`	Discontinued procedure	Use when the service is terminated prior to completion for safety concerns.
`23`	Unusual anesthesia	Use when general anesthesia is contraindicated and a documented unusual anesthesia circumstance is provided.

Taxonomy Code	Specialty	Notes
207L00000X	Vascular Surgery	Primary specialty performing arterial bypass and complex cervical vascular reconstructions.
2086S0124X	Neurological Surgery	Neurosurgeons may perform vertebral artery exposures and revascularizations.
2084P0800X	Thoracic Surgery	Thoracic/vascular surgeons may be involved when subclavian exposures or complex proximal reconstructions are required.
207K00000X	General Surgery	General surgeons with vascular training may perform in some centers.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I65.29`	Occlusion and stenosis of unspecified carotid artery	Relevant when proximal great vessel occlusive disease contributes to posterior circulation ischemia requiring revascularization.
`I65.23`	Occlusion and stenosis of bilateral vertebral arteries	Directly relevant when vertebral artery disease causes symptomatic posterior circulation ischemia and prompts surgical bypass.
`I63.9`	Cerebral infarction, unspecified	Represents ischemic stroke that may result from vertebrobasilar insufficiency and indicate need for revascularization.
`G45.9`	Transient ischemic attack, unspecified	TIAs with posterior circulation symptoms are common indications for definitive revascularization when medical therapy fails.
`I77.6`	Arteritis, unspecified	Vascular inflammatory conditions may involve vertebral arteries and necessitate bypass in select cases.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35800`	Common carotid to subclavian bypass, with interposition graft (when performed)	May be used when additional bypass from carotid to subclavian is required as part of complex revascularization strategies.
`34730`	Other extra-anatomic arteriovenous or arterial bypass procedures of head and neck (e.g., subclavian-vertebral bypass alternatives)	Represents alternative or adjunct bypass procedures in the head and neck circulation.
`36247`	Transluminal balloon angioplasty, open percutaneous, of the vertebral artery (each vessel)	Endovascular alternative to open surgical bypass; may be performed before deciding on bypass or as complementary therapy.
`36248`	Transluminal stent placement, vertebral artery (each vessel)	Endovascular stent placement may be performed as an alternative to open bypass when anatomy permits.
`76000`	Fluoroscopic guidance; initial exam	Intraoperative imaging/angiography to confirm graft patency and flow during revascularization.

CPT 35691: Vertebral to Carotid Artery Anastomosis

CPT-35694-SUBCLAVIAN-TO-CAROTID-ARTERY-BYPASS

CPT 35694: Subclavian-to-Carotid Arterial Bypass

CPT-35695-CAROTID-SUBCLAVIAN-BYPASS-ARTERIAL-BYPASS

CPT 35695: Carotid-Subclavian Arterial Bypass to Improve Blood Flow

CPT-35697-ARTERIAL-TRANSPOSITION-REIMPLANTATION

CPT 35697: Arterial Transposition and Reimplantation Procedures

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`11`	Normal (usual) postoperative recovery	Use when the procedure has a typical, uncomplicated postoperative course.
`22`	Increased procedural services	Use when substantial additional work is documented beyond typical for the procedure (e.g., extensive dissection or complex revision).
`52`	Reduced services	Use when the service performed is less than described by the CPT code (e.g., procedure started but aborted before completion).
`53`	Discontinued procedure	Use when the procedure is terminated due to extenuating circumstances or safety concerns prior to completion.
`62`	Two surgeons	Use when co-surgeons of different specialties are required and documented.
`66`	Surgical team approach	Use when a surgical team (multiple surgeons with distinct roles) is documented.
`78`	Unplanned return to the operating room	Use when the patient returns to the OR for a related procedure during the postoperative global period.
`80`	Assistant surgeon	Use when an assistant surgeon performs documented assistance during the procedure.
`81`	Minimum assistant surgeon	Use when only minimal assistant participation is documented.
`82`	Assistant surgeon (when qualified resident not available)	Use when a qualified resident is not available and an assistant is required.
`26`	Professional component	Use if billing an interpretation or professional component separate from technical services (rare for this operative code).
`50`	Bilateral procedure	Use if the surgical procedure is performed bilaterally and a bilateral modifier is required by payer policy.
`53`	Discontinued procedure	Use when the service is terminated prior to completion for safety concerns.
`23`	Unusual anesthesia	Use when general anesthesia is contraindicated and a documented unusual anesthesia circumstance is provided.

Taxonomy Code	Specialty	Notes
207L00000X	Vascular Surgery	Primary specialty performing arterial bypass and complex cervical vascular reconstructions.
2086S0124X	Neurological Surgery	Neurosurgeons may perform vertebral artery exposures and revascularizations.
2084P0800X	Thoracic Surgery	Thoracic/vascular surgeons may be involved when subclavian exposures or complex proximal reconstructions are required.
207K00000X	General Surgery	General surgeons with vascular training may perform in some centers.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I65.29`	Occlusion and stenosis of unspecified carotid artery	Relevant when proximal great vessel occlusive disease contributes to posterior circulation ischemia requiring revascularization.
`I65.23`	Occlusion and stenosis of bilateral vertebral arteries	Directly relevant when vertebral artery disease causes symptomatic posterior circulation ischemia and prompts surgical bypass.
`I63.9`	Cerebral infarction, unspecified	Represents ischemic stroke that may result from vertebrobasilar insufficiency and indicate need for revascularization.
`G45.9`	Transient ischemic attack, unspecified	TIAs with posterior circulation symptoms are common indications for definitive revascularization when medical therapy fails.
`I77.6`	Arteritis, unspecified	Vascular inflammatory conditions may involve vertebral arteries and necessitate bypass in select cases.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35800`	Common carotid to subclavian bypass, with interposition graft (when performed)	May be used when additional bypass from carotid to subclavian is required as part of complex revascularization strategies.
`34730`	Other extra-anatomic arteriovenous or arterial bypass procedures of head and neck (e.g., subclavian-vertebral bypass alternatives)	Represents alternative or adjunct bypass procedures in the head and neck circulation.
`36247`	Transluminal balloon angioplasty, open percutaneous, of the vertebral artery (each vessel)	Endovascular alternative to open surgical bypass; may be performed before deciding on bypass or as complementary therapy.
`36248`	Transluminal stent placement, vertebral artery (each vessel)	Endovascular stent placement may be performed as an alternative to open bypass when anatomy permits.
`76000`	Fluoroscopic guidance; initial exam	Intraoperative imaging/angiography to confirm graft patency and flow during revascularization.

CPT 35691: Vertebral to Carotid Artery Anastomosis

CPT-35694-SUBCLAVIAN-TO-CAROTID-ARTERY-BYPASS

CPT 35694: Subclavian-to-Carotid Arterial Bypass

CPT-35695-CAROTID-SUBCLAVIAN-BYPASS-ARTERIAL-BYPASS

CPT 35695: Carotid-Subclavian Arterial Bypass to Improve Blood Flow

CPT-35697-ARTERIAL-TRANSPOSITION-REIMPLANTATION

CPT 35697: Arterial Transposition and Reimplantation Procedures

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 35693: Vertebral-to-Subclavian Artery Bypass

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Billing Code Overview

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CPT 35693: Vertebral-to-Subclavian Artery Bypass

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References