CPT code 35521: Arterial bypass, axillary-to-femoral, vein conduit2026 Medicare rate & RVUs in Florida
Reports an open arterial bypass using vein from the axillary artery to one femoral artery to route blood around obstructed aortoiliac vessels.
CMS doesn’t publish an office rate for 35521 in Florida.
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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On this page 9 sections
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.
Where 35521 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | Unavailable | $1,283.11 |
| Miami, FL | Unavailable | $1,431.78 |
| Rest of Florida | Unavailable | $1,214.27 |
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
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.
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
| 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 · 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.
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).
35521 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 35621Arterial bypassAxillary inflow to femoral
- The route and single femoral target are the same, but 35621 is for a conduit other than vein; 35521 is for a vein conduit.
- 35533Arterial bypassVein graft, axillary-femoral-femoral
- Use 35533 when the axillary-to-femoral vein bypass branches to both femoral arteries. 35521 describes a single femoral outflow.
- 35539Aortic bypassSingle femoral target, vein conduit
- Both involve a vein bypass to a femoral artery, but 35539 uses aortic inflow; 35521 uses axillary inflow.
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
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