CPT code 35390: Carotid reoperation, repeat endarterectomy2026 Medicare rate & RVUs in Puerto Rico
Reports the added work of repeat carotid endarterectomy in a previously operated neck, alongside the primary code for the new carotid endarterectomy.
In Puerto Rico, Medicare pays $143.04 for 35390 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 35390 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 35390 covers
This add-on represents the additional operative work of performing carotid endarterectomy in a neck that has already undergone carotid surgery. A vascular surgeon may encounter this situation when treating recurrent narrowing at a previously operated carotid artery. The repeat operation involves working through the prior surgical field to address the recurrent disease; it is not simply another code for an initial carotid endarterectomy.
Report 35390 with the primary code for the carotid endarterectomy, generally 35301. The operative report should establish the prior carotid operation and document the current repeat endarterectomy. CMS treats this as an add-on: it is reported only with a primary procedure, and its payment falls within that procedure’s global period. Do not report it by itself to describe the repeat operation.
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 35390
Across 109 of 109 payment localities, the facility rate for 35390 runs from $124.48 in Wisconsin to $184.23 in Alaska. Puerto Rico pays $143.04. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$143.04
- Los Angeles, CA · California$141.07−$1.97
- Washington, DC area · District of Columbia$154.20+$11.16
- Miami, FL · Florida$184.17+$41.13
- Chicago, IL · Illinois$178.25+$35.21
- Manhattan, NY · New York$167.51+$24.47
- Alaska · Alaska$184.23+$41.19
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $130.21 |
| ArkansasArkansas | — | $128.66 |
| ArizonaArizona | — | $139.09 |
| Bakersfield, CACalifornia | — | $136.20 |
| Chico, CACalifornia | — | $134.06 |
| El Centro, CACalifornia | — | $134.19 |
| Fresno, CACalifornia | — | $134.06 |
| Hanford, CACalifornia | — | $134.06 |
| Madera, CACalifornia | — | $134.06 |
| Merced, CACalifornia | — | $134.06 |
| Modesto, CACalifornia | — | $134.06 |
| Napa, CACalifornia | — | $140.99 |
| Oxnard, CACalifornia | — | $138.62 |
| Redding, CACalifornia | — | $134.06 |
| Rest of CaliforniaCalifornia | — | $134.06 |
| Riverside, CACalifornia | — | $142.53 |
| Sacramento, CACalifornia | — | $136.91 |
| Salinas, CACalifornia | — | $136.34 |
| San Diego, CACalifornia | — | $136.87 |
| Marin County, CACalifornia | — | $144.22 |
| San Francisco, CACalifornia | — | $143.33 |
| San Benito County, CACalifornia | — | $148.23 |
| Santa Clara County, CACalifornia | — | $144.56 |
| San Luis Obispo, CACalifornia | — | $134.62 |
| Santa Cruz, CACalifornia | — | $136.03 |
| Santa Maria, CACalifornia | — | $136.12 |
| Santa Rosa, CACalifornia | — | $137.13 |
| Stockton, CACalifornia | — | $134.06 |
| Vallejo, CACalifornia | — | $139.70 |
| Visalia, CACalifornia | — | $134.06 |
| Yuba City, CACalifornia | — | $134.06 |
| ColoradoColorado | — | $139.59 |
| ConnecticutConnecticut | — | $151.91 |
| DelawareDelaware | — | $140.99 |
| Fort Lauderdale, FLFlorida | — | $164.78 |
| Rest of FloridaFlorida | — | $155.99 |
| Atlanta, GAGeorgia | — | $149.11 |
| Rest of GeorgiaGeorgia | — | $146.95 |
| Hawaii, Guam, HIHawaii | — | $133.97 |
| IowaIowa | — | $126.27 |
| IdahoIdaho | — | $128.34 |
| East St. Louis, ILIllinois | — | $169.00 |
| Rest of IllinoisIllinois | — | $157.01 |
| Suburban Chicago, ILIllinois | — | $164.74 |
| IndianaIndiana | — | $128.78 |
| KansasKansas | — | $128.95 |
| KentuckyKentucky | — | $139.60 |
| New Orleans, LALouisiana | — | $146.11 |
| Rest of LouisianaLouisiana | — | $140.68 |
| Metropolitan Boston, MAMassachusetts | — | $147.17 |
| Rest of MassachusettsMassachusetts | — | $140.29 |
| Baltimore area, MDMaryland | — | $152.16 |
| Rest of MarylandMaryland | — | $142.32 |
| Rest of MaineMaine | — | $132.27 |
| Southern Maine, MEMaine | — | $133.44 |
| Detroit, MIMichigan | — | $160.94 |
| Rest of MichiganMichigan | — | $145.56 |
| MinnesotaMinnesota | — | $125.09 |
| Metropolitan Kansas City, MOMissouri | — | $141.89 |
| Metropolitan St. Louis, MOMissouri | — | $142.72 |
| Rest of MissouriMissouri | — | $140.81 |
| MississippiMississippi | — | $134.59 |
| MontanaMontana | — | $143.24 |
| North CarolinaNorth Carolina | — | $132.89 |
| North DakotaNorth Dakota | — | $127.62 |
| NebraskaNebraska | — | $125.87 |
| New HampshireNew Hampshire | — | $140.53 |
| Northern New JerseyNew Jersey | — | $153.71 |
| Rest of New JerseyNew Jersey | — | $151.20 |
| New MexicoNew Mexico | — | $147.51 |
| NevadaNevada | — | $138.90 |
| NYC suburbs and Long Island, NYNew York | — | $175.01 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $154.74 |
| Queens, NYNew York | — | $163.97 |
| Rest of New YorkNew York | — | $134.80 |
| OhioOhio | — | $142.37 |
| OklahomaOklahoma | — | $136.01 |
| Portland, OROregon | — | $139.64 |
| Rest of OregonOregon | — | $135.40 |
| Metropolitan Philadelphia, PAPennsylvania | — | $150.79 |
| Rest of PennsylvaniaPennsylvania | — | $140.77 |
| Rhode IslandRhode Island | — | $142.84 |
| South CarolinaSouth Carolina | — | $138.34 |
| South DakotaSouth Dakota | — | $125.77 |
| TennesseeTennessee | — | $129.89 |
| Austin, TXTexas | — | $141.25 |
| Beaumont, TXTexas | — | $140.24 |
| Brazoria, TXTexas | — | $138.20 |
| Dallas, TXTexas | — | $140.43 |
| Fort Worth, TXTexas | — | $140.64 |
| Galveston, TXTexas | — | $139.49 |
| Houston, TXTexas | — | $153.95 |
| Rest of TexasTexas | — | $140.07 |
| UtahUtah | — | $139.82 |
| VirginiaVirginia | — | $135.31 |
| Virgin Islands, VIUnited States Virgin Islands | — | $143.04 |
| VermontVermont | — | $130.12 |
| Rest of WashingtonWashington | — | $139.02 |
| King County, WAWashington | — | $146.61 |
| WisconsinWisconsin | — | $124.48 |
| West VirginiaWest Virginia | — | $152.96 |
| WyomingWyoming | — | $136.43 |
35390 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 35390 rate is calculated
Each of 35390’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 · 35390
RVUs × geographic indexes × conversion factor
Work3.11
3.11 RVUs× 1.000 GPCI
Practice expense0.39
0.39 RVUs× 1.000 GPCI
Malpractice0.79
0.79 RVUs× 1.000 GPCI
Adjusted RVUs
4.2900
Conversion factor
$33.4009
Medicare rate
$143.29
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
4,328
- Code
- 35390
- Physician work
- 3.11
- Practice expense
- 0.39
- Malpractice
- 0.79
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.11 | × 1.000 | 3.1100 |
| Practice expense | 0.39 | × 1.011 | 0.3943 |
| Malpractice | 0.79 | × 0.985 | 0.7782 |
| Total RVUs | 4.2824 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Puerto Rico$143.04
Facility: (3.11 × 1 + 0.39 × 1.011 + 0.79 × 0.985) × $33.4009 = $143.04
Payment rules and modifiers for 35390
The CMS indicators that decide how 35390 is paid alongside other services.
CMS payment indicators · 35390
Carotid reoperation, repeat endarterectomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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. |
What modifiers do to the payment
Modifier 80 · payment effect
With and without the modifier
35390 without 80 · national facility
$143.29
Carotid reoperation, repeat endarterectomy
35390-80 · Assistant: 16%
$22.93
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
How 35390 has changed in Puerto Rico
35390 · 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 | $143.04 | RVU26D |
| 2026-07-01 | Not available in this setting | $143.04 | RVU26C |
| 2026-04-01 | Not available in this setting | $143.04 | RVU26B |
| 2026-01-01 | Not available in this setting | $143.04 | RVU26A |
| 2025-10-01 | Not available in this setting | $150.43 | RVU25D |
| 2025-07-01 | Not available in this setting | $150.43 | RVU25C |
| 2025-04-01 | Not available in this setting | $150.43 | RVU25B |
| 2025-01-01 | Not available in this setting | $150.43 | RVU25A |
| 2024-10-01 | Not available in this setting | $153.81 | RVU24D |
| 2024-07-01 | Not available in this setting | $153.81 | RVU24C |
| 2024-04-01 | Not available in this setting | $153.81 | RVU24B |
| 2024-03-09 | Not available in this setting | $153.81 | RVU24AR |
| 2024-01-01 | Not available in this setting | $151.30 | RVU24A |
| 2023-10-01 | Not available in this setting | $156.34 | RVU23D |
| 2023-07-01 | Not available in this setting | $156.56 | RVU23C |
| 2023-04-01 | Not available in this setting | $156.56 | RVU23B |
| 2023-01-01 | Not available in this setting | $156.56 | RVU23A |
| 2022-10-01 | Not available in this setting | $160.39 | RVU22D |
| 2022-07-01 | Not available in this setting | $160.39 | RVU22C |
| 2022-04-01 | Not available in this setting | $160.39 | RVU22B |
| 2022-01-01 | Not available in this setting | $160.39 | RVU22A |
| 2021-10-01 | Not available in this setting | $161.04 | RVU21D |
| 2021-07-01 | Not available in this setting | $161.04 | RVU21C |
| 2021-04-01 | Not available in this setting | $161.04 | RVU21B |
| 2021-01-01 | Not available in this setting | $161.04 | RVU21A |
| 2020-10-01 | Not available in this setting | $167.69 | RVU20D |
| 2020-07-01 | Not available in this setting | $167.69 | RVU20C |
| 2020-04-01 | Not available in this setting | $167.69 | RVU20B |
| 2020-01-01 | Not available in this setting | $167.69 | RVU20A |
| 2019-10-01 | Not available in this setting | $166.06 | RVU19D |
| 2019-07-01 | Not available in this setting | $166.06 | RVU19C |
| 2019-04-01 | Not available in this setting | $166.06 | RVU19B |
| 2019-01-01 | Not available in this setting | $166.06 | RVU19A |
| 2018-10-01 | Not available in this setting | $166.96 | RVU18D |
| 2018-07-01 | Not available in this setting | $166.96 | RVU18C |
| 2018-04-01 | Not available in this setting | $166.96 | RVU18B |
| 2018-01-01 | Not available in this setting | $166.96 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $154.73 | RVU17D |
| 2017-07-01 | Not available in this setting | $154.73 | RVU17C |
| 2017-04-01 | Not available in this setting | $154.73 | RVU17B |
| 2017-01-01 | Not available in this setting | $154.73 | RVU17A |
| 2016-10-01 | Not available in this setting | $141.82 | RVU16D |
| 2016-07-01 | Not available in this setting | $141.82 | RVU16C |
| 2016-04-01 | Not available in this setting | $141.82 | RVU16B |
| 2016-01-01 | Not available in this setting | $141.82 | RVU16A |
| 2015-10-01 | Not available in this setting | $142.69 | RVU15D |
| 2015-07-01 | Not available in this setting | $142.69 | RVU15C |
| 2015-04-01 | Not available in this setting | $141.98 | RVU15B |
| 2015-01-01 | Not available in this setting | $141.98 | RVU15A |
| 2014-10-01 | Not available in this setting | $141.40 | RVU14D |
| 2014-07-01 | Not available in this setting | $141.40 | RVU14C |
| 2014-04-01 | Not available in this setting | $141.40 | RVU14B |
| 2014-01-01 | Not available in this setting | $141.40 | RVU14A |
| 2013-10-01 | Not available in this setting | $136.40 | RVU13D |
| 2013-07-01 | Not available in this setting | $136.40 | RVU13C |
| 2013-04-01 | Not available in this setting | $136.40 | RVU13B |
| 2013-01-01 | Not available in this setting | $136.40 | 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
35390 billing questions
When should 35390 be reported with 35301?
Report it when the current carotid endarterectomy is a reoperation in a previously operated carotid field. Code 35301 describes the primary endarterectomy; 35390 captures the added reoperative work.
Can 35390 be submitted without a primary procedure code?
No. It is an add-on code and must be reported with the primary carotid endarterectomy procedure.
What documentation supports the add-on?
The operative report should identify the prior carotid operation and describe the current repeat endarterectomy in that previously operated field.
Is 35390 used for an initial carotid endarterectomy?
No. An initial carotid endarterectomy is reported with the applicable primary procedure code; 35390 represents reoperative work.
How does the global-period rule affect payment?
CMS pays this add-on within the global period of the primary procedure. It is not a separately reportable stand-alone service.
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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