CPT code 35516: Arterial bypass, subclavian to axillary2026 Medicare rate & RVUs in Massachusetts
Reports a vein-graft bypass connecting the subclavian and axillary arteries to restore upper-extremity blood flow when direct flow is inadequate.
CMS doesn’t publish an office rate for 35516 in Massachusetts.
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 35516 covers
A vascular surgeon uses a vein conduit to route blood from the subclavian artery to the axillary artery, bypassing a segment that cannot provide adequate flow. The operation may be considered for upper-extremity ischemia caused by obstructive arterial disease when this specific inflow and outflow route is selected. The operative report should identify both anastomotic sites and describe the bypass performed.
Report this code for the subclavian-to-axillary route, not simply because the operation involves the shoulder or arm. Documentation should support the indication, the arteries connected, and the conduit used; separately performed vein harvest may be reportable when supported. Medicare assigns a 90-day major-surgery global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in one session, the highest-valued is paid in full and others at 50%. For bilateral performance, modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; 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.
Where 35516 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | $1,143.40 |
| Rest of Massachusetts | Unavailable | $1,088.01 |
How the 35516 rate is calculated
Each of 35516’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 · 35516
RVUs × geographic indexes × conversion factor
Work23.60
23.60 RVUs× 1.000 GPCI
Practice expense3.60
3.60 RVUs× 1.000 GPCI
Malpractice6.03
6.03 RVUs× 1.000 GPCI
Adjusted RVUs
33.2300
Conversion factor
$33.4009
Medicare rate
$1,109.91
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 35516
35516 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35516
Arterial bypass, subclavian to axillary
| 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 · 35516
Arterial bypass, subclavian to axillary
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
35516 without 50 · national facility
$1,109.91
Arterial bypass, subclavian to axillary
35516-50 · Bilateral: 150%
$1,664.87
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).
35516 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 35512Arterial bypassSubclavian-to-brachial route
- Use 35516 when the bypass runs from the subclavian artery to the axillary artery. Use 35512 when the distal connection is the brachial artery.
- 35511Artery bypassSubclavian to subclavian, vein graft
- 35511 connects one subclavian artery to the other; 35516 connects a subclavian artery to an axillary artery.
- 35518Arterial bypassAxillary to axillary
- 35518 describes an axillary-to-axillary bypass. This code requires a subclavian origin and an axillary destination.
- 35515Arterial bypassSubclavian to vertebral
- 35515 connects the subclavian and vertebral arteries. Choose this code when the documented distal target is the axillary artery.
35516 billing questions
What distinguishes this code from a subclavian-to-brachial bypass?
This code describes a bypass whose distal connection is the axillary artery. Use the subclavian-to-brachial code when the documented distal anastomosis is in the brachial artery.
What operative details support reporting this code?
Document the subclavian and axillary connection sites, the bypass route, the vein conduit, and the clinical reason for revascularization.
Is vein harvest included in this bypass code?
The bypass code describes the graft reconstruction. When vein is harvested as a separate service, review the operative documentation for separate reporting, including the applicable harvest code.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and related postoperative care during the 90-day period are included in the global surgery payment.
How is bilateral performance handled?
For bypasses performed bilaterally, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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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