CPT code 35321: Arterial endarterectomy, axillary-brachial artery2026 Medicare rate & RVUs in Guam
Open removal of obstructive plaque from an axillary or brachial artery, with patch closure when needed, for upper-extremity arterial disease.
CMS doesn’t publish an office rate for 35321 in Guam.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 35321 covers
A vascular surgeon uses an open approach to remove obstructive material from an axillary or brachial artery and restore blood flow. A patch may be used to close or widen the artery as part of the repair. This operation is typically performed in a hospital operating room for upper-extremity arterial occlusive disease, such as impaired arm or hand circulation from atherosclerotic narrowing.
Report this code when the treated artery is axillary or brachial; choose a different endarterectomy code when the operative site is another named arterial territory. The operative report should identify the artery and side, describe the plaque removal, and document any patch repair. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery services may be paid; co-surgeon payment requires 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.
35321 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | $787.97 |
How the 35321 rate is calculated
Each of 35321’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 · 35321
RVUs × geographic indexes × conversion factor
Work16.18
16.18 RVUs× 1.000 GPCI
Practice expense4.41
4.41 RVUs× 1.000 GPCI
Malpractice4.14
4.14 RVUs× 1.000 GPCI
Adjusted RVUs
24.7300
Conversion factor
$33.4009
Medicare rate
$826.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 35321
35321 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35321
Arterial endarterectomy, axillary-brachial artery
| 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 · 35321
Arterial endarterectomy, axillary-brachial artery
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
35321 without 50 · national facility
$826.00
Arterial endarterectomy, axillary-brachial artery
35321-50 · Bilateral: 150%
$1,239.00
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).
35321 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 35301Arterial endarterectomyCarotid, vertebral, or subclavian
- Choose 35321 for axillary or brachial artery endarterectomy; 35301 is for the carotid, vertebral, or subclavian territory.
- 35311Arterial endarterectomyBrachiocephalic trunk
- 35311 applies to the innominate artery. The treated vessel, rather than the general endarterectomy technique, distinguishes it from 35321.
- 35371Arterial endarterectomyFemoral, profunda, or popliteal
- 35371 is used for femoral artery endarterectomy. Use 35321 when the operative site is the axillary or brachial artery.
35321 billing questions
How do I distinguish this code from 35301?
Use 35321 for endarterectomy of the axillary or brachial artery. Code 35301 describes endarterectomy in the carotid, vertebral, or subclavian territory.
Is patch closure separately reported?
A patch used as part of the artery repair is included in this service. Document whether a patch was used and the operative work performed.
What supports reporting this code?
The operative report should identify the axillary or brachial artery, the side, and the open removal of obstructive material. Include the patch repair details when one is performed.
How is bilateral treatment reported?
For bilateral procedures, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation.
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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