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    v1.0.30
    OpenPayerBilling CodesArterial Transposition ProceduresCPT cpt-35697-arterial-transposition-reimplantation
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    CPT 35697: Arterial Transposition/Reimplantation, Two Arteries

    Medicare pays $132 on average nationally for this procedure.

    CPT code 35697 describes an arterial transposition and/or reimplantation procedure in which two arteries are surgically connected to improve arterial blood flow; this is a vascular surgical service typically performed in the operating room or surgical suite and classified as a major vascular reconstructive procedure.

    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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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult presenting with symptomatic peripheral arterial disease or a congenital/iatrogenic arterial anomaly causing limb ischemia or compromised blood flow to an end-organ territory. The patient has progressive claudication, rest pain, non-healing ischemic ulceration, or acute limb ischemia despite conservative management. Diagnostic workup includes arterial duplex ultrasound, CT angiography or MR angiography confirming a lesion or malpositioned arterial origin amenable to arterial transposition or reimplantation. Preoperative evaluation entails vascular surgery consultation, cardiopulmonary risk assessment, optimization of anticoagulation/antiplatelet therapy, and informed consent explaining risks of bleeding, graft failure, infection, and limb loss.

    The clinical workflow: the patient is admitted for an elective or urgent vascular operation. In the operating room or hybrid suite, under general or regional anesthesia, the vascular surgeon exposes the involved arteries, mobilizes the donor and recipient arteries, performs arterial transposition and/or reimplantation with end-to-end or end-to-side anastomosis, and confirms flow with intraoperative duplex or angiography. Postoperative care includes monitoring in PACU or ICU as indicated, vascular assessments of distal pulses, anticoagulation management, wound care, and scheduled imaging follow-up to assess patency. Typical documentation includes preoperative diagnosis, indication for revascularization, detailed operative note describing arteries connected, method of anastomosis, graft or patch use if any, intraoperative findings, and postoperative plan.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    35206Bypass graft, with vein; femoral to below-knee popliteal, single segmentPerformed when transposition/reimplantation is not feasible and a bypass is required for limb revascularization.
    35476Endarterectomy, femoral artery; with vein patchOften performed in the same operative setting when endarterectomy is indicated adjacent to the area of transposition.
    36247Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family, with angiographyUsed intraoperatively or preoperatively for angiographic mapping to guide reimplantation.
    93503Insertion and placement of flow-directed catheter (e.g., Swan-Ganz) for monitoringUsed perioperatively in high-risk patients requiring advanced hemodynamic monitoring.
    99238Hospital discharge day management; 30 minutes or lessUsed for billing postoperative hospital discharge related to the inpatient stay after this procedure.

    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…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    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
    207R00000X
    208D00000X
    207L00000X
    261QS0132X
    261QM0850X
    207PP0204X
    332BN1400X
    237600000X

    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-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 Artery Bypass, Surgical Revascularization

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

    CPT 35695: Carotid-to-Subclavian Arterial 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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