CPT code 35646: Aortic bypass, to both femoral arteries2026 Medicare rate & RVUs

Medicare pays $1,543.12 for 35646 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 35646 covers

A vascular surgeon uses a conduit other than vein, typically a synthetic graft, to route blood from the aorta to the femoral artery in each groin. This operation is commonly performed in an operating room for extensive aortoiliac occlusive disease causing significant lower-extremity ischemia. The graft’s two limbs provide anatomic outflow to both sides; the operative report should identify the aortic inflow, both femoral targets, and conduit material.

Report this code when the bypass runs from the aorta to both femoral arteries using a non-vein conduit. Documentation should establish the indication, graft route and material, and the two distal anastomoses. 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 other procedures are subject to the standard 50% reduction. An assistant at surgery may be paid; 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 35646 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

35646 rates by state

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

How the 35646 rate is calculated

Each of 35646’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 35646

35646 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 51

35646 compared with similar codes

How to choose

35647Aortic bypassSingle femoral target

Use 35646 when the aortic bypass reaches both femoral arteries. Use 35647 when it reaches one femoral artery.

35521Arterial bypassAxillary-to-femoral, vein conduit

Both describe an aortic-to-femoral bypass, but 35521 is the vein-conduit alternative; 35646 uses a conduit other than vein and reaches both femoral arteries.

35638Aortic bypassBilateral iliac targets

35638 routes the aortic bypass to both iliac arteries. 35646 routes it to both femoral arteries.

35654Arterial bypassAxillary inflow, both femorals

35654 uses axillary inflow with a femoral-femoral configuration. 35646 uses aortic inflow and reaches both femoral arteries.

Codes related to 35646

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