CPT 35881 Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 35881: Lower Extremity Bypass Graft Vein Segment Replacement

CPT code 35881 represents a vascular surgical procedure that uses a harvested vein segment to replace a narrowed portion of a lower extremity arterial bypass graft. This revision or repair is clinically significant because it addresses graft stenosis or graft failure, which can threaten limb perfusion and increase the risk of limb loss. Nationwide, such procedures are performed across inpatient and outpatient surgical settings and are relevant to hospitals, vascular surgeons, and payers managing complex peripheral arterial disease care.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and the types of metrics and policy issues commonly associated with reimbursement and utilization for graft revision procedures. The publication outlines benchmarks and payment considerations, highlights typical clinical indications for performing a vein-segment replacement in a lower extremity bypass graft, and summarizes common payer coverage patterns and claims considerations. It also identifies areas where additional coding specificity or documentation can affect coverage and claims processing.

Data not available in the input is noted where applicable; the summary focuses on nationally relevant clinical and billing context rather than state-specific rules.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 35881vascular surgerylower extremitybypass graft repairgraft revisionsurgical procedureperipheral arterial diseasehospital services

Billing Code Overview

CPT code 35881 describes a surgical procedure in which a harvested vein segment is used to replace a narrowed portion of a lower extremity arterial bypass graft. This procedure is a vascular surgical revision aiming to restore or improve blood flow in a previously placed arterial bypass within the leg.

Service Type: Vascular surgical graft revision / bypass graft repair

Typical Site of Service: Hospital operating room (inpatient or outpatient surgical setting) or ambulatory surgery center, depending on patient condition and clinical need.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male with a history of peripheral arterial disease and prior femoropopliteal bypass presents with progressive rest pain and a nonhealing ulcer on the lateral foot. Duplex ultrasound and CT angiography demonstrate a focal stenosis and venous segment degeneration within the existing lower extremity bypass graft. The vascular surgery team schedules an operative reintervention under general anesthesia in an ambulatory surgery center or hospital operating room. Intraoperatively the surgeon harvests an autologous vein segment (commonly the contralateral great saphenous vein or an arm vein), excises the narrowed portion of the existing graft, and interposes the harvested vein as a patch or segmental bypass conduit to restore adequate inflow and distal perfusion. Postoperative workflow includes surgical site monitoring, anticoagulation management, vascular ultrasound surveillance prior to discharge, and documentation of graft revision technique, vein harvest site, laterality, and any complications. Typical sites of service include the hospital operating room or ambulatory surgical center for an open vascular bypass revision.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing physician separately from facility for interpretation or professional surgical services when technical and professional components are split (rare for open surgery).

CPT 35883: Open Femoral Patch Graft Revision of Synthetic Bypass

CPT-35875-VASCULAR-GRAFT-THROMBECTOMY-NON-HEMODIALYSIS

CPT 35875: Removal of Clot from Non-Hemodialysis Vascular Graft

CPT-35860-EXTREMITY-RE-EXPLORATION-FOR-BLEEDING-CLOTTING-INFECTION

CPT 35860: Re-exploration of Arm or Leg for Bleeding, Clotting, or Infection

CPT-35702-UPPER-EXTREMITY-VASCULAR-EXPLORATION-NO-REPAIR

CPT 35702: Upper Extremity Vascular Exploration, No Repair

CPT-35800-NECK-WOUND-EXPLORATION-CONTROL-BLEEDING-INFECTION

CPT 35800: Neck Exploration for Bleeding, Clot, or Infection

CPT-35703-LOWER-EXTREMITY-ARTERIAL-EXPLORATION-NO-REPAIR

CPT 35703: Exploratory Lower-Extremity Arterial Procedure Without Repair

CPT-35884-FEMORAL-ARTERIAL-BYPASS-GRAFT-PATCH-GRAFT-REVISION

CPT 35884: Femoral Arterial Bypass Graft Patch Graft Revision

CPT-35905-EXCISION-INFECTED-THORACIC-GRAFT

CPT 35905: Excision of Infected Thoracic Graft

CPT-35870-GRAFT-ENTERIC-FISTULA-REPAIR

CPT 35870: Repair of Vascular Graft‑to‑Intestine Fistula

CPT-35700-ARTERIAL-BYPASS-GRAFT-REOPERATION

CPT 35700: Reoperation on Arterial Bypass Graft

Showing 1–10 of 18

Taxonomy Code	Specialty	Notes
`208800000X`	Vascular Surgery	Primary specialty performing lower extremity bypass and graft revisions.
`207L00000X`	General Surgery	General surgeons with vascular practice perform peripheral bypass revisions in some centers.
`207RG0100X`	Thoracic and Cardiac Surgery	Cardiac/vascular surgeons with peripheral vascular expertise who manage complex graft reconstructions.
`2088P0800X`	Interventional Cardiology	May be involved for hybrid procedures though open graft revision is typically surgical.
`2080S0004X`	Critical Care Medicine	Provides perioperative critical care for high-risk vascular patients.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.219`	Atherosclerosis of native arteries of extremities, unspecified other extremity, with intermittent claudication	Peripheral arterial disease causing graft failure or progression leading to need for graft revision.
`I74.3`	Embolism and thrombosis of arteries of lower extremity	Acute or chronic thrombotic events can cause graft stenosis or occlusion prompting graft revision or replacement.
`I96`	Gangrene, not elsewhere classified	Advanced ischemia with tissue loss that may require restoration of perfusion via graft revision.
`I70.338`	Atherosclerosis of autologous vein bypass graft of the extremities, unspecified extremity	Direct graft atherosclerotic disease affecting autogenous vein grafts prompting segmental replacement.
`T82.828A`	Mechanical complication of other vascular grafts and implants, initial encounter	Represents graft degeneration or mechanical issues requiring revision or replacement.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`34001`	Revision or repair of existing peripheral (noncoronary) arterial bypass graft; graft of autogenous vein	Performed when shorter graft revision or patch angioplasty of autogenous vein graft is required; may be an alternative or component of graft revision.
`35656`	Open thrombectomy, femoral-popliteal bypass graft; with or without replacement, including revision (distinct code for thrombectomy)	Used when thrombus removal from a bypass graft is required in addition to or instead of segmental vein replacement.
`35701`	Revision or repair of existing peripheral arterial bypass graft; with patch angioplasty	May be reported when the narrowed graft segment is repaired with patch angioplasty rather than segmental replacement.
`36415`	Collection of venous blood by venipuncture	Preoperative laboratory monitoring commonly performed for anticoagulation management.
`76937`	Ultrasound guidance for vascular access (limited)	May be reported if ultrasound guidance is used for intraoperative vascular access or vein harvest localization.
`99100`	Anesthesia for patient of extreme age, younger than 1 year and older than 70 (if applicable)	May be appended to anesthesia billing when patient qualifies for advanced age modifier per payer rules.

OpenPayer