CPT code 35638: Aortic bypass, bilateral iliac targets2026 Medicare rate & RVUs in Missouri
Reports open bypass from the aorta to both iliac arteries using a non-vein graft, typically to restore blood flow in aortoiliac disease.
CMS doesn’t publish an office rate for 35638 in Missouri.
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 35638 covers
A vascular surgeon performs an open bypass from the aorta to both iliac arteries using a graft other than vein, commonly a synthetic conduit. The operation may be performed for aortoiliac occlusive disease when reconstruction is needed to restore blood flow to both lower extremities. The key distinction is that the graft runs from the aorta to bilateral iliac artery targets, rather than to the femoral arteries.
Select this code when the operative report supports the aortic origin, both iliac outflow targets, and use of a non-vein graft. CMS assigns 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 are subject to the standard 50% reduction. Modifier 50 is inappropriate for this bilateral configuration. 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 35638 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $1,562.00 |
| Metropolitan St. Louis, MO | Unavailable | $1,571.65 |
| Rest of Missouri | Unavailable | $1,544.97 |
How the 35638 rate is calculated
Each of 35638’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 · 35638
RVUs × geographic indexes × conversion factor
Work32.76
32.76 RVUs× 1.000 GPCI
Practice expense6.30
6.30 RVUs× 1.000 GPCI
Malpractice8.28
8.28 RVUs× 1.000 GPCI
Adjusted RVUs
47.3400
Conversion factor
$33.4009
Medicare rate
$1,581.20
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 35638
35638 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35638
Aortic bypass, bilateral iliac targets
| 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) | 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. |
| 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 · 35638
Aortic bypass, bilateral iliac targets
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 51 · payment effect
With and without the modifier
35638 without 51 · national facility
$1,581.20
Aortic bypass, bilateral iliac targets
35638-51 · Second procedure: 50%
$790.60
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
35638 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 35637Aortoiliac bypassAorta to one iliac artery
- This code identifies a bypass from the aorta to both iliac arteries. Distinguish the aortoiliac code by the documented target configuration rather than assuming bilateral iliac targets.
- 35646Aortic bypassTo both femoral arteries
- Both codes describe aortic bypasses, but this code has iliac artery targets; 35646 has bilateral femoral artery targets.
- 35647Aortic bypassSingle femoral target
- This code has bilateral iliac targets. 35647 is the aortofemoral alternative when the operative report identifies a femoral artery target.
35638 billing questions
How does this differ from an aortobifemoral bypass?
This code describes aortic inflow with both iliac arteries as the distal targets. An aortobifemoral bypass has femoral artery targets instead.
When should the single aortoiliac bypass code be considered instead?
Use the bilateral-target code when the graft runs from the aorta to both iliac arteries. Aortoiliac bypass is the neighboring choice for a different, non-bilateral iliac configuration.
Should modifier 50 be appended for the two iliac targets?
No. CMS identifies bilateral adjustment as inappropriate for this code; the bilateral iliac configuration is represented by the service itself.
What operative documentation supports this code?
Document the aortic origin, both iliac artery targets, and that the conduit is not vein. The report should make clear that the distal targets are iliac arteries rather than femoral arteries.
How are other procedures in the same session handled?
CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full and other procedures are reduced when performed in the same session. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation.
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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