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

CPT code 35695 represents a carotid-to-subclavian arterial bypass procedure performed to bypass a localized arterial blockage and restore or improve blood flow to the head and neck. As a major vascular surgery, this code captures complex open surgical management of carotid and subclavian arterial disease and is relevant for hospital surgical billing, preauthorization workflows, and vascular surgery quality measurement. Nationally, accurate reporting of 35695 affects surgical case mix, resource allocation in operating rooms, and Medicare and commercial payer payment pathways for major vascular reconstructions.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The content outlines typical clinical indications and the usual inpatient surgical setting, and it summarizes the payer landscape relevant to authorization and claims processing.

Readers will learn clinical context for the procedure, standard sites of service, the primary payers engaged in coverage and claims, and where to find related coding guidance. Data not available in the input is noted where applicable, and readers will find a concise reference for operational and billing teams managing cases involving CPT code 35695.

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Billing Code Overview

CPT code 35695 describes a surgical arterial bypass procedure in which the provider fully exposes the carotid artery, divides it, and anastomoses the artery to the subclavian artery to bypass an area of arterial blockage. This service is performed to improve arterial blood flow to the head and neck.

Service type: Surgical arterial bypass (carotid-subclavian bypass)
Typical site of service: Inpatient operating room or surgical suite (hospital-based surgical setting)

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

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Billing Code Overview

Service type: Surgical arterial bypass (carotid-subclavian bypass)
Typical site of service: Inpatient operating room or surgical suite (hospital-based surgical setting)

Clinical & Coding Specifications

Clinical Context

A typical patient is a 65-year-old with symptomatic extracranial carotid artery occlusive disease and recurrent transient ischemic attacks (TIAs) despite medical therapy. The vascular surgery team evaluates carotid-subclavian bypass as a surgical option when proximal common carotid or innominate/subclavian atherosclerotic disease, prior radiation, or anatomic constraints make direct carotid endarterectomy or stenting unsuitable. Preoperative workflow includes vascular imaging (CT angiography or duplex ultrasound) confirming focal occlusion or high-grade stenosis and assessment of cerebral perfusion and cardiac risk. The patient is counseled on risks and benefits and scheduled for open surgical bypass under general anesthesia. Intraoperatively, the surgeon fully exposes the carotid artery, divides it as needed, and performs an anastomosis to the subclavian artery to bypass the obstructed segment and restore arterial inflow to the cerebral circulation. Postoperative care includes neurologic monitoring, blood pressure management, antiplatelet therapy, and surveillance duplex studies during follow-up to confirm graft patency.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal, uncomplicated service	Use when the procedure is the primary service with typical intraoperative and postoperative course.
`22`	Increased procedural services	Use when work is substantially greater than usual (e.g., extensive dissection from scar or prior radiation) and well-documented.
`23`	Unusual anesthesia	Use when procedure performed under general anesthesia but circumstances require significantly more anesthesia than usual (rare for this code).
`26`	Professional component	Use if reporting only the physician professional component separate from facility billing (rare for surgical CPT).
`50`	Bilateral procedure	Use when bilateral carotid-subclavian bypasses are performed (very uncommon); append to appropriate bilateral-instance coding per payer rules.
`52`	Reduced services	Use when a partially completed procedure is performed and documented as reduced in scope.
`53`	Discontinued procedure	Use when procedure begun but terminated due to extenuating circumstances, documented and supported.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`63`	Procedure performed on infants less than 4 kg	Typically not applicable; included for completeness when patient size modifier is required by payer.
`78`	Return to OR for related procedure during postoperative period	Use when patient returns to operating room for a related unplanned procedure during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon is required and documented.
`81`	Minimum assistant surgeon	Use when a minimal assistance is documented per payer rules.
`82`	Assistant surgeon (when qualified resident surgeon not available)	Use when no resident available and an assistant surgeon is required.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant surgeon	Use when an advanced practice clinician provided assistant surgeon services allowed by payer.

Taxonomy Code	Specialty	Notes
`207RX0400X`	Vascular Surgery	Primary specialty performing carotid-subclavian bypass and complex carotid revascularization.
`2080P0208X`	Thoracic and Cardiac Surgery	May perform procedures involving proximal great vessel reconstruction when combined pathology exists.
`207L00000X`	General Surgery	Some general surgeons with vascular training perform extra-anatomic bypass procedures.
`207RC0000X`	Cardiac Surgery	In centers where cardiac surgeons manage proximal subclavian/innominate disease and cerebrovascular perfusion issues.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I65.21`	Occlusion and stenosis of right carotid artery	High-grade carotid occlusive disease prompting bypass to restore flow.
`I65.22`	Occlusion and stenosis of left carotid artery	Lateralized carotid disease that may require surgical extra-anatomic bypass.
`I70.2`	Atherosclerosis of native arteries of the extremities (peripheral)	Reflects systemic atherosclerotic disease often associated with great vessel occlusive disease (used when relevant peripheral disease documented).
`I74.3`	Embolism and thrombosis of arteries of the lower extremities	Thromboembolic events can coexist; included when arterial thrombosis influences revascularization strategy.
`G45.9`	Transient cerebral ischemic attack, unspecified	TIAs are common indications for carotid revascularization procedures to prevent stroke.
`I77.1`	Stricture of artery	Arterial strictures of brachiocephalic or subclavian vessels may necessitate bypass when not amenable to endovascular repair.
`Z95.1`	Presence of aortocoronary bypass graft	Relevant in preoperative assessment where prior bypass grafts alter surgical planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35301`	Contralateral carotid to subclavian artery bypass, includes harvesting of graft if performed	Alternative or related extra-anatomic bypass for subclavian or carotid inflow issues; may be performed in similar clinical scenarios.
`35556`	Endarterectomy, carotid artery, with patch graft; with or without shunt, when performed	Carotid endarterectomy is a primary revascularization method that may be used instead of bypass when lesion is accessible.
`37220`	Revascularization, endovascular, open or percutaneous arterial intervention, including angioplasty and stent of extracranial carotid artery	Endovascular carotid intervention is an alternative to open bypass in selected patients; may occur pre- or post-operatively for adjunctive lesions.
`36147`	Transcatheter placement of intravascular stent(s), other than coronary, any method, including angioplasty when performed; for occlusive disease of subclavian or innominate arteries	Endovascular treatment of proximal subclavian stenosis that may preclude or obviate need for surgical bypass; can be performed in hybrid procedures.
`36478`	Endovascular repair, arterial; thrombolytic therapy infusion for acute limb ischemia or arterial thrombosis	Occasionally used when thrombotic occlusion is present and thrombolysis is attempted as adjunct before or after surgical bypass.

CPT 35691: Vertebral to Carotid Artery Anastomosis

CPT-35693-VERTEBRAL-TO-SUBCLAVIAN-ARTERY-BYPASS

CPT 35693: Vertebral-to-Subclavian Artery Bypass

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

CPT 35694: Subclavian-to-Carotid Arterial Bypass

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.

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, uncomplicated service	Use when the procedure is the primary service with typical intraoperative and postoperative course.
`22`	Increased procedural services	Use when work is substantially greater than usual (e.g., extensive dissection from scar or prior radiation) and well-documented.
`23`	Unusual anesthesia	Use when procedure performed under general anesthesia but circumstances require significantly more anesthesia than usual (rare for this code).
`26`	Professional component	Use if reporting only the physician professional component separate from facility billing (rare for surgical CPT).
`50`	Bilateral procedure	Use when bilateral carotid-subclavian bypasses are performed (very uncommon); append to appropriate bilateral-instance coding per payer rules.
`52`	Reduced services	Use when a partially completed procedure is performed and documented as reduced in scope.
`53`	Discontinued procedure	Use when procedure begun but terminated due to extenuating circumstances, documented and supported.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`63`	Procedure performed on infants less than 4 kg	Typically not applicable; included for completeness when patient size modifier is required by payer.
`78`	Return to OR for related procedure during postoperative period	Use when patient returns to operating room for a related unplanned procedure during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon is required and documented.
`81`	Minimum assistant surgeon	Use when a minimal assistance is documented per payer rules.
`82`	Assistant surgeon (when qualified resident surgeon not available)	Use when no resident available and an assistant surgeon is required.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant surgeon	Use when an advanced practice clinician provided assistant surgeon services allowed by payer.

Taxonomy Code	Specialty	Notes
`207RX0400X`	Vascular Surgery	Primary specialty performing carotid-subclavian bypass and complex carotid revascularization.
`2080P0208X`	Thoracic and Cardiac Surgery	May perform procedures involving proximal great vessel reconstruction when combined pathology exists.
`207L00000X`	General Surgery	Some general surgeons with vascular training perform extra-anatomic bypass procedures.
`207RC0000X`	Cardiac Surgery	In centers where cardiac surgeons manage proximal subclavian/innominate disease and cerebrovascular perfusion issues.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I65.21`	Occlusion and stenosis of right carotid artery	High-grade carotid occlusive disease prompting bypass to restore flow.
`I65.22`	Occlusion and stenosis of left carotid artery	Lateralized carotid disease that may require surgical extra-anatomic bypass.
`I70.2`	Atherosclerosis of native arteries of the extremities (peripheral)	Reflects systemic atherosclerotic disease often associated with great vessel occlusive disease (used when relevant peripheral disease documented).
`I74.3`	Embolism and thrombosis of arteries of the lower extremities	Thromboembolic events can coexist; included when arterial thrombosis influences revascularization strategy.
`G45.9`	Transient cerebral ischemic attack, unspecified	TIAs are common indications for carotid revascularization procedures to prevent stroke.
`I77.1`	Stricture of artery	Arterial strictures of brachiocephalic or subclavian vessels may necessitate bypass when not amenable to endovascular repair.
`Z95.1`	Presence of aortocoronary bypass graft	Relevant in preoperative assessment where prior bypass grafts alter surgical planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`35301`	Contralateral carotid to subclavian artery bypass, includes harvesting of graft if performed	Alternative or related extra-anatomic bypass for subclavian or carotid inflow issues; may be performed in similar clinical scenarios.
`35556`	Endarterectomy, carotid artery, with patch graft; with or without shunt, when performed	Carotid endarterectomy is a primary revascularization method that may be used instead of bypass when lesion is accessible.
`37220`	Revascularization, endovascular, open or percutaneous arterial intervention, including angioplasty and stent of extracranial carotid artery	Endovascular carotid intervention is an alternative to open bypass in selected patients; may occur pre- or post-operatively for adjunctive lesions.
`36147`	Transcatheter placement of intravascular stent(s), other than coronary, any method, including angioplasty when performed; for occlusive disease of subclavian or innominate arteries	Endovascular treatment of proximal subclavian stenosis that may preclude or obviate need for surgical bypass; can be performed in hybrid procedures.
`36478`	Endovascular repair, arterial; thrombolytic therapy infusion for acute limb ischemia or arterial thrombosis	Occasionally used when thrombotic occlusion is present and thrombolysis is attempted as adjunct before or after surgical bypass.

CPT 35691: Vertebral to Carotid Artery Anastomosis

CPT-35693-VERTEBRAL-TO-SUBCLAVIAN-ARTERY-BYPASS

CPT 35693: Vertebral-to-Subclavian Artery Bypass

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

CPT 35694: Subclavian-to-Carotid Arterial Bypass

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.

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

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Billing Code Overview

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

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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