C1604 Transmural Transvenous Bypass | HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS C1604: Implantable Transmural Transvenous Arterial Bypass Graft

HCPCS Level II code C1604 designates an implantable graft for a transmural transvenous arterial bypass supplied with all delivery system components. Such implantable vascular devices are critical in complex vascular and cardiothoracic procedures where reestablishing arterial flow via a transvenous route is required. Nationally, these devices influence surgical planning, device procurement, and billing classification for high-acuity vascular interventions.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, payer coverage landscape, common modifiers seen with device and procedure billing, and related coding considerations. The publication covers benchmarks and policy considerations relevant to hospital and inpatient billing for implantable vascular grafts, highlights areas where coverage variation commonly appears, and summarizes coding guidance tied to device supply and delivery components. This summary is intended for revenue integrity, clinical coding, and supply chain stakeholders who manage high-cost implantable vascular devices and need a clear, national-level synopsis of HCPCS Level II code C1604.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC1604HCPCS Level IIimplantable vascular graftvascular surgerydevice billinginpatient surgerytransvenous arterial bypasssurgical implantsmedical device coding

Billing Code Overview

HCPCS Level II code C1604 represents an implantable graft device for transmural transvenous arterial bypass, supplied with all delivery system components. This device is used to create an arterial bypass via a transvenous approach for transmural graft placement.

Service type: Implantable vascular graft with delivery system components
Typical site of service: Hospital operating room or inpatient surgical setting for vascular or cardiothoracic procedures

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with severe peripheral arterial disease or complex venous-arterial access needs who requires a transmural transvenous arterial bypass graft implantable device (C1604) to restore arterial perfusion. The patient often presents with chronic limb-threatening ischemia, rest pain, non-healing ischemic ulceration, or recurrent graft failure after prior reconstructive attempts. Preoperative evaluation includes vascular imaging (duplex ultrasound, CTA or MRA, and diagnostic angiography), cardiopulmonary assessment, medication optimization (antiplatelet and/or anticoagulation management), and wound care consultation if tissue loss is present.

The clinical workflow: the patient is brought to a hybrid operating room or interventional radiology suite. Under general or monitored anesthesia care, vascular access is obtained percutaneously or via open exposure. The transmural transvenous arterial bypass graft and delivery system (C1604) are implanted using fluoroscopic and endovascular techniques, often with adjunctive angioplasty or stenting. Intraoperative angiography confirms graft position and flow. Postprocedure care includes vascular monitoring, limb perfusion checks, anticoagulation management, wound care, and surveillance imaging at planned intervals. Typical sites of service are an inpatient operating room, ambulatory surgery center, or an interventional radiology suite within a hospital setting depending on patient acuity and facility capabilities.

Coding Specifications

Modifier	Description	When to Use

HCPCS C1603: IVC Filter Retrieval Laser Device

HCPCS-C1601-DISPOSABLE-PULMONARY-ENDOSCOPE-IMAGING

HCPCS C1601: Single-use Pulmonary Endoscope for Imaging/Illumination

HCPCS-C1600-INTRAVASCULAR-LESION-PREPARATION-BLADED-CATHETER

HCPCS C1600: Intravascular Lesion Preparation Catheter, Bladed

HCPCS-C1602-ABSORBABLE-ANTIMICROBIAL-BONE-VOID-FILLER-IMPLANTABLE

HCPCS C1602: Absorbable Antimicrobial-Eluting Bone Void Filler, Implantable

HCPCS-C1605-LEADLESS-DUAL-CHAMBER-PACEMAKER-IMPLANTATION

HCPCS C1605: Leadless Dual-Chamber Pacemaker Implantation

HCPCS-C1607-IMPLANTABLE-RECHARGEABLE-NEUROSTIMULATOR-INTEGRATED

HCPCS C1607: Implantable Rechargeable Neurostimulator, Integrated

HCPCS-C1608-TOTAL-DUAL-MOBILITY-FIRST-CARPOMETACARPAL-PROSTHESIS

HCPCS C1608: Prosthesis, Total Dual Mobility, First Carpometacarpal Joint

HCPCS-C1606-ENDOSCOPIC-ULTRASOUND-ADAPTER-DISPOSABLE

HCPCS C1606: Single-Use Adapter for Upper GI Endoscope Ultrasound

Taxonomy Code	Specialty	Notes
`207K00000X`	Vascular Surgery	Primary specialty performing complex arterial bypass and implantable vascular devices.
`207L00000X`	Interventional Cardiology	Performs endovascular arterial interventions and device placements in select cases.
`2084P0800X`	Interventional Radiology	Commonly performs image-guided implantation of endovascular graft systems.
`207RI0001X`	Thoracic and Cardiac Surgery	May be involved when grafting involves thoracic arterial segments or complex reconstruction.
`363L00000X`	General Surgery	General surgeons with vascular training may perform peripheral bypass and graft implantation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I70.23`	Atherosclerosis of native arteries of the extremities with ulceration, bilateral legs	Indicates advanced peripheral arterial disease leading to ischemic ulcers that may require bypass grafting.
`I70.24`	Atherosclerosis of native arteries of the extremities with gangrene, bilateral legs	Severe ischemia with tissue loss or gangrene often necessitating revascularization with implantable grafts.
`I74.3`	Embolism and thrombosis of arteries of lower extremity	Acute arterial occlusion that may require bypass or implantable graft solutions for limb salvage.
`I96`	Gangrene, not elsewhere classified	Advanced tissue necrosis secondary to ischemia; revascularization is part of limb salvage efforts.
`I73.9`	Peripheral vascular disease, unspecified	General indication for vascular interventions including bypass graft implantation for symptomatic disease.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`93458`	Catheter placement, arterial, for diagnostic angiography, including intraprocedural injection(s) for selective angiography, imaging supervision and interpretation when performed; each additional vascular family	Diagnostic angiography frequently performed before or during graft implantation to map arterial anatomy and confirm placement.
`75960`	Angiography, vascular, noncoronary, radiological supervision and interpretation	Performed for pre- or intra-procedural imaging to document blood flow and graft function.
`37227`	Revascularization, endovascular, open or percutaneous, femoral-popliteal artery, includes transluminal angioplasty, stent placement when performed	Often performed adjunctively when treating peripheral arterial disease in the same session as graft implantation.
`33999`	Unlisted procedure, cardiac or pericardial	May be used for reporting novel or unlisted complex implantable bypass systems when no specific CPT exists.
`32998`	Insertion of special arterial bypass graft device, implantable (unlisted)	Used when an implantable transmural transvenous arterial bypass device does not have a specific CPT code and an unlisted code is required.

OpenPayer