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    OpenPayerBilling CodesArterial Transposition ProceduresCPT cpt-35693-vertebral-to-subclavian-artery-bypass
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    CPT 35693: Vertebral to Subclavian Artery Bypass

    Medicare pays $768 on average nationally for this procedure.

    CPT code 35693 describes an open surgical arterial bypass in which the provider fully exposes the vertebral artery, divides it, and anastomoses it to the subclavian artery to bypass an occluded segment and improve arterial blood flow; this service is a vascular bypass procedure typically performed in the operating room for patients with vertebrobasilar or proximal subclavian occlusive disease to restore cerebral and upper-extremity perfusion.

    For related coverage guidance, see recent payer policy updates: Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure, Cardiology - Ivabradine, Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA).

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    Table of contents

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    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    35800Common 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.
    34730Other 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.
    36247Transluminal 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.
    36248Transluminal stent placement, vertebral artery (each vessel)Endovascular stent placement may be performed as an alternative to open bypass when anatomy permits.
    76000Fluoroscopic guidance; initial examIntraoperative imaging/angiography to confirm graft patency and flow during revascularization.

    Related Modifiers

    12 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…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    2084P0800X
    207K00000X
    164W00000X
    1835P1400X
    364SX0200X
    111NS0005X
    2251E1200X

    Related Payer Policy Updates

    Specialty: Cardiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood PressureBluecross Idaho2026-11-01
    Cardiology - IvabradineCigna2026-10-15
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Percutaneous Ventricular Assist DeviceUnitedHealthcare2026-10-01
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Left Atrial Appendage Closure Devicesexcellus_health_plan_inc2026-09-17
    Left Atrial Appendage Closure Devicesuniverahealthcare2026-09-17
    Cardiac Omnibus CodesCigna2026-09-15

    Related Codes

    CPT-35691-VERTEBRAL-TO-CAROTID-ARTERY-ANASTOMOSIS

    CPT 35691: Vertebral Artery to Carotid Anastomosis

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

    CPT 35694: Subclavian-to-Carotid Artery Bypass, Surgical Revascularization

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

    CPT 35695: Carotid-to-Subclavian Arterial Bypass

    CPT-35697-ARTERIAL-TRANSPOSITION-REIMPLANTATION

    CPT 35697: Arterial Transposition/Reimplantation, Two Arteries

    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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