CPT code 35509: Carotid bypass, contralateral carotid, vein graft2026 Medicare rate & RVUs

Medicare pays $1,284.60 for 35509 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 35509 covers

This operation uses a vein conduit to connect one carotid artery to the carotid artery on the opposite side of the neck, creating a route for blood flow around a diseased or obstructed segment. A vascular surgeon typically performs the reconstruction in an operating room. The operative report should identify both carotid endpoints and the vein graft so the cross-neck bypass can be distinguished from a bypass on one side or a reconstruction involving another artery.

Select this code when the documented bypass connects contralateral carotid arteries using a vein graft. Documentation should support the conduit, the donor and recipient vessels, and the completed bypass. Medicare treats the service as major surgery with a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 for a bilateral procedure is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with 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.

Where 35509 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

35509 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 35509 rate is calculated

Each of 35509’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.

Payment rules and modifiers for 35509

35509 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

35509 compared with similar codes

How to choose

35501Carotid bypassIpsilateral carotid-to-carotid

Both describe vein-graft carotid bypasses; 35501 applies to a bypass on the same side, while this code connects carotid arteries across the neck.

35506Arterial bypassSubclavian to carotid

35506 uses a subclavian artery and a carotid artery as the bypass endpoints. This code connects carotid arteries on opposite sides.

35508Arterial bypassCarotid to vertebral

35508 connects a carotid artery to a vertebral artery. This code is selected when the bypass endpoints are contralateral carotid arteries.

Codes related to 35509

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates