CPT code 35521: Arterial bypass, axillary-to-femoral, vein conduit2026 Medicare rate & RVUs in Washington, DC area

Reports an open arterial bypass using vein from the axillary artery to one femoral artery to route blood around obstructed aortoiliac vessels.

CMS RVU26DEffective Oct 1, 2026One payment locality

In Washington, DC area, Medicare pays $1,207.58 for 35521 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)
$1,207.58Hospital or facility

Check a contract rate as a % of Medicare · 35521 nationwide

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

We’ll open 35521 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 35521 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 35521 covers

A vascular surgeon creates an extra-anatomic route from the axillary artery to a femoral artery using a vein conduit. This can restore lower-extremity blood flow when severe aortoiliac occlusive disease makes a direct aortic reconstruction unsuitable. The operation is performed in an operating room and includes the graft route and its arterial connections. The code identifies a single femoral outflow; a reconstruction branching to both femoral arteries is a different service.

Select the code when the operative report supports an axillary inflow, one femoral target, and a vein conduit. Document the bypass path, target artery, conduit, and laterality. The service has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with 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.

How Washington, DC area compares for 35521

Across 109 of 109 payment localities, the facility rate for 35521 runs from $974.25 in Wisconsin to $1,431.78 in Miami, FL. Washington, DC area pays $1,207.58. The RVUs are the same everywhere; the geographic indexes change the dollars.

35521 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$1,207.58
  2. Los Angeles, CA · California$1,107.74−$99.84
  3. Miami, FL · Florida$1,431.78+$224.20
  4. Chicago, IL · Illinois$1,385.48+$177.90
  5. Manhattan, NY · New York$1,308.43+$100.85
  6. Alaska · Alaska$1,430.19+$222.61
  7. Alabama · Alabama$1,015.17−$192.41

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

35521 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas—$1,002.81
ArizonaArizona—$1,085.89
Bakersfield, CACalifornia—$1,067.91
Chico, CACalifornia—$1,051.66
El Centro, CACalifornia—$1,052.66
Fresno, CACalifornia—$1,051.66
Hanford, CACalifornia—$1,051.66
Madera, CACalifornia—$1,051.66

35521 rates by state

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

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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
35521 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

See 35521 in every payment locality

How the 35521 rate is calculated

Each of 35521’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 · 35521

RVUs × geographic indexes × conversion factor

Office or facility?

Work23.53

23.53 RVUs× 1.000 GPCI

Practice expense3.95

3.95 RVUs× 1.000 GPCI

Malpractice6.02

6.02 RVUs× 1.000 GPCI

Adjusted RVUs

33.5000

Conversion factor

$33.4009

Medicare rate

$1,118.93

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,343

Code
35521
Physician work
23.53
Practice expense
3.95
Malpractice
6.02

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Facility calculation for 35521 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work23.53× 1.05424.8006
Practice expense3.95× 1.1784.6531
Malpractice6.02× 1.1136.7003
Total RVUs36.1540
Conversion factor× 33.4009

Facility rate, Washington, DC area$1207.58

Facility: (23.53 × 1.054 + 3.95 × 1.178 + 6.02 × 1.113) × $33.4009 = $1207.58

Open 35521 in the RVU calculator

Payment rules and modifiers for 35521

35521 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 35521

Arterial bypass, axillary-to-femoral, vein conduit

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.84/0.07Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 35521

Arterial bypass, axillary-to-femoral, vein conduit

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

35521 without 50 · national facility

$1,118.93

Arterial bypass, axillary-to-femoral, vein conduit

35521-50 · Bilateral: 150%

$1,678.40

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).

When to use modifier 50

How 35521 has changed in Washington, DC area

35521 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

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
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Not available in this setting$1,207.58RVU26D
2026-07-01Not available in this setting$1,207.58RVU26C
2026-04-01Not available in this setting$1,207.58RVU26B
2026-01-01Not available in this setting$1,207.58RVU26A
2025-10-01Not available in this setting$1,281.54RVU25D
2025-07-01Not available in this setting$1,281.54RVU25C
2025-04-01Not available in this setting$1,281.54RVU25B
2025-01-01Not available in this setting$1,281.54RVU25A
2024-10-01Not available in this setting$1,315.20RVU24D
2024-07-01Not available in this setting$1,315.20RVU24C
2024-04-01Not available in this setting$1,315.20RVU24B
2024-03-09Not available in this setting$1,315.20RVU24AR
2024-01-01Not available in this setting$1,293.73RVU24A
2023-10-01Not available in this setting$1,348.19RVU23D
2023-07-01Not available in this setting$1,348.19RVU23C
2023-04-01Not available in this setting$1,348.19RVU23B
2023-01-01Not available in this setting$1,348.19RVU23A
2022-10-01Not available in this setting$1,399.11RVU22D
2022-07-01Not available in this setting$1,399.11RVU22C
2022-04-01Not available in this setting$1,399.11RVU22B
2022-01-01Not available in this setting$1,399.11RVU22A
2021-10-01Not available in this setting$1,396.07RVU21D
2021-07-01Not available in this setting$1,396.07RVU21C
2021-04-01Not available in this setting$1,396.07RVU21B
2021-01-01Not available in this setting$1,396.07RVU21A
2020-10-01Not available in this setting$1,431.51RVU20D
2020-07-01Not available in this setting$1,431.51RVU20C
2020-04-01Not available in this setting$1,431.51RVU20B
2020-01-01Not available in this setting$1,431.51RVU20A
2019-10-01Not available in this setting$1,409.86RVU19D
2019-07-01Not available in this setting$1,409.86RVU19C
2019-04-01Not available in this setting$1,405.77RVU19B
2019-01-01Not available in this setting$1,405.77RVU19A
2018-10-01Not available in this setting$1,416.89RVU18D
2018-07-01Not available in this setting$1,416.89RVU18C
2018-04-01Not available in this setting$1,416.89RVU18B
2018-01-01Not available in this setting$1,416.89RVU18AR1
2017-10-01Not available in this setting$1,429.74RVU17D
2017-07-01Not available in this setting$1,429.74RVU17C
2017-04-01Not available in this setting$1,429.74RVU17B
2017-01-01Not available in this setting$1,429.74RVU17A
2016-10-01Not available in this setting$1,461.12RVU16D
2016-07-01Not available in this setting$1,461.12RVU16C
2016-04-01Not available in this setting$1,461.12RVU16B
2016-01-01Not available in this setting$1,461.12RVU16A
2015-10-01Not available in this setting$1,457.51RVU15D
2015-07-01Not available in this setting$1,457.51RVU15C
2015-04-01Not available in this setting$1,450.26RVU15B
2015-01-01Not available in this setting$1,450.26RVU15A
2014-10-01Not available in this setting$1,444.30RVU14D
2014-07-01Not available in this setting$1,444.30RVU14C
2014-04-01Not available in this setting$1,444.30RVU14B
2014-01-01Not available in this setting$1,444.30RVU14A
2013-10-01Not available in this setting$1,618.30RVU13D
2013-07-01Not available in this setting$1,618.30RVU13C
2013-04-01Not available in this setting$1,618.30RVU13B
2013-01-01Not available in this setting$1,618.30RVU13AR

Price 35521 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

35521 billing questions

When should 35521 be selected instead of 35621?

Use 35521 for an axillary-to-femoral bypass using a vein conduit. Code 35621 is the corresponding axillary-to-femoral bypass using a conduit other than vein.

Does 35521 describe a bypass to both femoral arteries?

No. It describes one femoral outflow. A single axillary inflow graft that branches to both femoral arteries is represented by 35533 when performed with vein.

What operative details support reporting 35521?

Document the axillary inflow, the femoral target and laterality, the vein conduit, and the bypass route. The report should make clear whether the graft reaches one femoral artery or branches to both.

How does the 90-day global period affect follow-up billing?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period. The bypass is major surgery.

How does Medicare treat bilateral reporting and surgical assistance?

A bilateral procedure reported with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeons require supporting documentation, and 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
RVUs for 35521PPRRVU2026_Oct_nonQPP.csv, line 4,343 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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