CPT code 35246: Vessel repair, intrathoracic, without bypass2026 Medicare rate & RVUs in Puerto Rico
Reports reconstruction of an intrathoracic blood vessel with a vein graft when the repair restores the vessel without creating a bypass route.
In Puerto Rico, Medicare pays $1,484.49 for 35246 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 35246 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 35246 covers
A surgeon uses a vein graft to repair a damaged or diseased blood vessel inside the chest, restoring continuity at the site rather than routing blood around it. This may be needed during open thoracic surgery for an injury or when removing a diseased vessel segment leaves a defect that requires graft reconstruction. Vascular, thoracic, or cardiothoracic surgeons typically perform the operation in a hospital operating room.
Select this code when the operative report supports both the intrathoracic location and use of a vein graft, and shows that the reconstruction is not a bypass. Document the vessel repaired, the graft material, and the repair performed. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. For procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 bilateral reporting is paid at 150%. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and team surgery is not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Puerto Rico compares for 35246
Across 109 of 109 payment localities, the facility rate for 35246 runs from $1,317.21 in Wisconsin to $1,867.17 in Alaska. Puerto Rico pays $1,484.49. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$1,484.49
- Los Angeles, CA · California$1,510.81+$26.32
- Washington, DC area · District of Columbia$1,619.87+$135.38
- Miami, FL · Florida$1,834.69+$350.20
- Chicago, IL · Illinois$1,777.20+$292.71
- Manhattan, NY · New York$1,727.66+$243.17
- Alaska · Alaska$1,867.17+$382.68
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $1,345.39 |
| ArkansasArkansas | — | $1,328.65 |
| ArizonaArizona | — | $1,441.62 |
| Bakersfield, CACalifornia | — | $1,448.49 |
| Chico, CACalifornia | — | $1,430.59 |
| El Centro, CACalifornia | — | $1,431.69 |
| Fresno, CACalifornia | — | $1,430.59 |
| Hanford, CACalifornia | — | $1,430.59 |
| Madera, CACalifornia | — | $1,430.59 |
| Merced, CACalifornia | — | $1,430.59 |
| Modesto, CACalifornia | — | $1,430.59 |
| Napa, CACalifornia | — | $1,543.23 |
| Oxnard, CACalifornia | — | $1,489.49 |
| Redding, CACalifornia | — | $1,430.59 |
| Rest of CaliforniaCalifornia | — | $1,430.59 |
| Riverside, CACalifornia | — | $1,501.28 |
| Sacramento, CACalifornia | — | $1,471.15 |
| Salinas, CACalifornia | — | $1,465.17 |
| San Diego, CACalifornia | — | $1,478.33 |
| Marin County, CACalifornia | — | $1,593.57 |
| San Francisco, CACalifornia | — | $1,586.09 |
| San Benito County, CACalifornia | — | $1,635.34 |
| Santa Clara County, CACalifornia | — | $1,604.74 |
| San Luis Obispo, CACalifornia | — | $1,445.41 |
| Santa Cruz, CACalifornia | — | $1,475.28 |
| Santa Maria, CACalifornia | — | $1,464.83 |
| Santa Rosa, CACalifornia | — | $1,488.04 |
| Stockton, CACalifornia | — | $1,430.59 |
| Vallejo, CACalifornia | — | $1,532.44 |
| Visalia, CACalifornia | — | $1,430.59 |
| Yuba City, CACalifornia | — | $1,430.59 |
| ColoradoColorado | — | $1,468.89 |
| ConnecticutConnecticut | — | $1,575.15 |
| DelawareDelaware | — | $1,462.23 |
| Fort Lauderdale, FLFlorida | — | $1,666.33 |
| Rest of FloridaFlorida | — | $1,579.55 |
| Atlanta, GAGeorgia | — | $1,536.52 |
| Rest of GeorgiaGeorgia | — | $1,489.04 |
| Hawaii, Guam, HIHawaii | — | $1,438.56 |
| IowaIowa | — | $1,321.98 |
| IdahoIdaho | — | $1,340.43 |
| East St. Louis, ILIllinois | — | $1,679.62 |
| Rest of IllinoisIllinois | — | $1,577.94 |
| Suburban Chicago, ILIllinois | — | $1,669.67 |
| IndianaIndiana | — | $1,345.70 |
| KansasKansas | — | $1,341.74 |
| KentuckyKentucky | — | $1,427.03 |
| New Orleans, LALouisiana | — | $1,493.60 |
| Rest of LouisianaLouisiana | — | $1,435.12 |
| Metropolitan Boston, MAMassachusetts | — | $1,564.35 |
| Rest of MassachusettsMassachusetts | — | $1,472.30 |
| Baltimore area, MDMaryland | — | $1,576.04 |
| Rest of MarylandMaryland | — | $1,479.28 |
| Rest of MaineMaine | — | $1,373.22 |
| Southern Maine, MEMaine | — | $1,399.68 |
| Detroit, MIMichigan | — | $1,622.93 |
| Rest of MichiganMichigan | — | $1,482.41 |
| MinnesotaMinnesota | — | $1,339.04 |
| Metropolitan Kansas City, MOMissouri | — | $1,457.91 |
| Metropolitan St. Louis, MOMissouri | — | $1,467.90 |
| Rest of MissouriMissouri | — | $1,430.71 |
| MississippiMississippi | — | $1,378.64 |
| MontanaMontana | — | $1,483.56 |
| North CarolinaNorth Carolina | — | $1,381.45 |
| North DakotaNorth Dakota | — | $1,353.26 |
| NebraskaNebraska | — | $1,320.55 |
| New HampshireNew Hampshire | — | $1,470.62 |
| Northern New JerseyNew Jersey | — | $1,612.03 |
| Rest of New JerseyNew Jersey | — | $1,573.83 |
| New MexicoNew Mexico | — | $1,499.63 |
| NevadaNevada | — | $1,447.59 |
| NYC suburbs and Long Island, NYNew York | — | $1,796.61 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $1,604.34 |
| Queens, NYNew York | — | $1,702.85 |
| Rest of New YorkNew York | — | $1,401.39 |
| OhioOhio | — | $1,455.77 |
| OklahomaOklahoma | — | $1,398.03 |
| Portland, OROregon | — | $1,480.62 |
| Rest of OregonOregon | — | $1,417.25 |
| Metropolitan Philadelphia, PAPennsylvania | — | $1,557.16 |
| Rest of PennsylvaniaPennsylvania | — | $1,443.63 |
| Rhode IslandRhode Island | — | $1,489.07 |
| South CarolinaSouth Carolina | — | $1,424.79 |
| South DakotaSouth Dakota | — | $1,337.85 |
| TennesseeTennessee | — | $1,350.72 |
| Austin, TXTexas | — | $1,480.74 |
| Beaumont, TXTexas | — | $1,437.35 |
| Brazoria, TXTexas | — | $1,439.83 |
| Dallas, TXTexas | — | $1,459.64 |
| Fort Worth, TXTexas | — | $1,459.05 |
| Galveston, TXTexas | — | $1,451.08 |
| Houston, TXTexas | — | $1,571.70 |
| Rest of TexasTexas | — | $1,445.07 |
| UtahUtah | — | $1,440.87 |
| VirginiaVirginia | — | $1,413.43 |
| Virgin Islands, VIUnited States Virgin Islands | — | $1,484.49 |
| VermontVermont | — | $1,371.82 |
| Rest of WashingtonWashington | — | $1,461.61 |
| King County, WAWashington | — | $1,567.93 |
| WisconsinWisconsin | — | $1,317.21 |
| West VirginiaWest Virginia | — | $1,533.71 |
| WyomingWyoming | — | $1,426.77 |
35246 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
How the 35246 rate is calculated
Each of 35246’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 35246
RVUs × geographic indexes × conversion factor
Work27.52
27.52 RVUs× 1.000 GPCI
Practice expense10.32
10.32 RVUs× 1.000 GPCI
Malpractice6.59
6.59 RVUs× 1.000 GPCI
Adjusted RVUs
44.4300
Conversion factor
$33.4009
Medicare rate
$1,484.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
4,303
- Code
- 35246
- Physician work
- 27.52
- Practice expense
- 10.32
- Malpractice
- 6.59
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 27.52 | × 1.000 | 27.5200 |
| Practice expense | 10.32 | × 1.011 | 10.4335 |
| Malpractice | 6.59 | × 0.985 | 6.4912 |
| Total RVUs | 44.4447 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Puerto Rico$1484.49
Facility: (27.52 × 1 + 10.32 × 1.011 + 6.59 × 0.985) × $33.4009 = $1484.49
Payment rules and modifiers for 35246
35246 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35246
Vessel repair, intrathoracic, without bypass
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 35246
Vessel repair, intrathoracic, without bypass
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
35246 without 50 · national facility
$1,484.00
Vessel repair, intrathoracic, without bypass
35246-50 · Bilateral: 150%
$2,226.00
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
How 35246 has changed in Puerto Rico
35246 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1,484.49 | RVU26D |
| 2026-07-01 | Not available in this setting | $1,484.49 | RVU26C |
| 2026-04-01 | Not available in this setting | $1,484.49 | RVU26B |
| 2026-01-01 | Not available in this setting | $1,484.49 | RVU26A |
| 2025-10-01 | Not available in this setting | $1,490.00 | RVU25D |
| 2025-07-01 | Not available in this setting | $1,490.00 | RVU25C |
| 2025-04-01 | Not available in this setting | $1,490.00 | RVU25B |
| 2025-01-01 | Not available in this setting | $1,490.00 | RVU25A |
| 2024-10-01 | Not available in this setting | $1,525.57 | RVU24D |
| 2024-07-01 | Not available in this setting | $1,525.57 | RVU24C |
| 2024-04-01 | Not available in this setting | $1,525.57 | RVU24B |
| 2024-03-09 | Not available in this setting | $1,525.57 | RVU24AR |
| 2024-01-01 | Not available in this setting | $1,500.67 | RVU24A |
| 2023-10-01 | Not available in this setting | $1,551.29 | RVU23D |
| 2023-07-01 | Not available in this setting | $1,551.69 | RVU23C |
| 2023-04-01 | Not available in this setting | $1,551.69 | RVU23B |
| 2023-01-01 | Not available in this setting | $1,551.69 | RVU23A |
| 2022-10-01 | Not available in this setting | $1,589.69 | RVU22D |
| 2022-07-01 | Not available in this setting | $1,589.69 | RVU22C |
| 2022-04-01 | Not available in this setting | $1,589.69 | RVU22B |
| 2022-01-01 | Not available in this setting | $1,589.69 | RVU22A |
| 2021-10-01 | Not available in this setting | $1,595.27 | RVU21D |
| 2021-07-01 | Not available in this setting | $1,595.27 | RVU21C |
| 2021-04-01 | Not available in this setting | $1,595.27 | RVU21B |
| 2021-01-01 | Not available in this setting | $1,595.27 | RVU21A |
| 2020-10-01 | Not available in this setting | $1,634.84 | RVU20D |
| 2020-07-01 | Not available in this setting | $1,634.84 | RVU20C |
| 2020-04-01 | Not available in this setting | $1,634.84 | RVU20B |
| 2020-01-01 | Not available in this setting | $1,634.84 | RVU20A |
| 2019-10-01 | Not available in this setting | $1,644.41 | RVU19D |
| 2019-07-01 | Not available in this setting | $1,644.41 | RVU19C |
| 2019-04-01 | Not available in this setting | $1,631.57 | RVU19B |
| 2019-01-01 | Not available in this setting | $1,631.57 | RVU19A |
| 2018-10-01 | Not available in this setting | $1,641.57 | RVU18D |
| 2018-07-01 | Not available in this setting | $1,641.57 | RVU18C |
| 2018-04-01 | Not available in this setting | $1,641.57 | RVU18B |
| 2018-01-01 | Not available in this setting | $1,641.57 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $1,502.52 | RVU17D |
| 2017-07-01 | Not available in this setting | $1,502.52 | RVU17C |
| 2017-04-01 | Not available in this setting | $1,502.52 | RVU17B |
| 2017-01-01 | Not available in this setting | $1,502.52 | RVU17A |
| 2016-10-01 | Not available in this setting | $1,366.18 | RVU16D |
| 2016-07-01 | Not available in this setting | $1,366.18 | RVU16C |
| 2016-04-01 | Not available in this setting | $1,366.18 | RVU16B |
| 2016-01-01 | Not available in this setting | $1,366.18 | RVU16A |
| 2015-10-01 | Not available in this setting | $1,370.47 | RVU15D |
| 2015-07-01 | Not available in this setting | $1,370.47 | RVU15C |
| 2015-04-01 | Not available in this setting | $1,363.65 | RVU15B |
| 2015-01-01 | Not available in this setting | $1,363.65 | RVU15A |
| 2014-10-01 | Not available in this setting | $1,346.93 | RVU14D |
| 2014-07-01 | Not available in this setting | $1,346.93 | RVU14C |
| 2014-04-01 | Not available in this setting | $1,346.93 | RVU14B |
| 2014-01-01 | Not available in this setting | $1,346.93 | RVU14A |
| 2013-10-01 | Not available in this setting | $1,225.30 | RVU13D |
| 2013-07-01 | Not available in this setting | $1,225.30 | RVU13C |
| 2013-04-01 | Not available in this setting | $1,225.30 | RVU13B |
| 2013-01-01 | Not available in this setting | $1,225.30 | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
35246 billing questions
How does this differ from 35241?
Both describe intrathoracic vessel repair using a vein graft. Use 35246 when the reconstruction is without bypass; 35241 is the with-bypass counterpart.
When would direct vessel repair be more appropriate?
If the surgeon repairs the intrathoracic vessel directly without using a graft, consider 35216 when the repair is without bypass.
What operative documentation supports 35246?
The report should identify the intrathoracic vessel, the vein graft used, and how the graft reconstructs the vessel without creating a bypass route.
How is bilateral reporting handled?
When the procedure is performed bilaterally, modifier 50 applies; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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