CPT code 35646: Aortic bypass, to both femoral arteries2026 Medicare rate & RVUs in Arkansas
Reports a non-vein bypass from the aorta to both femoral arteries, commonly performed to restore lower-extremity blood flow in aortoiliac occlusive disease.
In Arkansas, Medicare pays $1,383.13 for 35646 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 35646 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How Arkansas compares for 35646
Across 109 of 109 payment localities, the facility rate for 35646 runs from $1,346.05 in Wisconsin to $1,970.43 in Alaska. Arkansas pays $1,383.13. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Arkansas · this page$1,383.13
- Los Angeles, CA · California$1,531.35+$148.22
- Washington, DC area · District of Columbia$1,666.86+$283.73
- Miami, FL · Florida$1,968.40+$585.27
- Chicago, IL · Illinois$1,905.01+$521.88
- Manhattan, NY · New York$1,803.54+$420.41
- Alaska · Alaska$1,970.43+$587.30
Other areas in Arkansas first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $1,400.18 |
| ArizonaArizona | — | $1,497.75 |
| Bakersfield, CACalifornia | — | $1,475.65 |
| Chico, CACalifornia | — | $1,453.59 |
| El Centro, CACalifornia | — | $1,454.95 |
| Fresno, CACalifornia | — | $1,453.59 |
| Hanford, CACalifornia | — | $1,453.59 |
| Madera, CACalifornia | — | $1,453.59 |
| Merced, CACalifornia | — | $1,453.59 |
| Modesto, CACalifornia | — | $1,453.59 |
| Napa, CACalifornia | — | $1,538.88 |
| Oxnard, CACalifornia | — | $1,506.00 |
| Redding, CACalifornia | — | $1,453.59 |
| Rest of CaliforniaCalifornia | — | $1,453.59 |
| Riverside, CACalifornia | — | $1,541.16 |
| Sacramento, CACalifornia | — | $1,487.13 |
| Salinas, CACalifornia | — | $1,480.98 |
| San Diego, CACalifornia | — | $1,488.79 |
| Marin County, CACalifornia | — | $1,577.92 |
| San Francisco, CACalifornia | — | $1,568.64 |
| San Benito County, CACalifornia | — | $1,621.32 |
| Santa Clara County, CACalifornia | — | $1,583.39 |
| San Luis Obispo, CACalifornia | — | $1,462.02 |
| Santa Cruz, CACalifornia | — | $1,481.21 |
| Santa Maria, CACalifornia | — | $1,479.13 |
| Santa Rosa, CACalifornia | — | $1,493.43 |
| Stockton, CACalifornia | — | $1,453.59 |
| Vallejo, CACalifornia | — | $1,525.51 |
| Visalia, CACalifornia | — | $1,453.59 |
| Yuba City, CACalifornia | — | $1,453.59 |
| ColoradoColorado | — | $1,508.80 |
| ConnecticutConnecticut | — | $1,637.01 |
| DelawareDelaware | — | $1,518.58 |
| Fort Lauderdale, FLFlorida | — | $1,766.16 |
| Rest of FloridaFlorida | — | $1,671.76 |
| Atlanta, GAGeorgia | — | $1,604.33 |
| Rest of GeorgiaGeorgia | — | $1,574.34 |
| Hawaii, Guam, HIHawaii | — | $1,455.10 |
| IowaIowa | — | $1,361.91 |
| IdahoIdaho | — | $1,383.63 |
| East St. Louis, ILIllinois | — | $1,804.14 |
| Rest of IllinoisIllinois | — | $1,679.70 |
| Suburban Chicago, ILIllinois | — | $1,766.60 |
| IndianaIndiana | — | $1,388.55 |
| KansasKansas | — | $1,388.95 |
| KentuckyKentucky | — | $1,498.16 |
| New Orleans, LALouisiana | — | $1,568.67 |
| Rest of LouisianaLouisiana | — | $1,509.11 |
| Metropolitan Boston, MAMassachusetts | — | $1,595.18 |
| Rest of MassachusettsMassachusetts | — | $1,515.30 |
| Baltimore area, MDMaryland | — | $1,639.29 |
| Rest of MarylandMaryland | — | $1,533.84 |
| Rest of MaineMaine | — | $1,424.29 |
| Southern Maine, MEMaine | — | $1,440.66 |
| Detroit, MIMichigan | — | $1,723.46 |
| Rest of MichiganMichigan | — | $1,561.27 |
| MinnesotaMinnesota | — | $1,356.70 |
| Metropolitan Kansas City, MOMissouri | — | $1,524.89 |
| Metropolitan St. Louis, MOMissouri | — | $1,534.26 |
| Rest of MissouriMissouri | — | $1,508.97 |
| MississippiMississippi | — | $1,444.65 |
| MontanaMontana | — | $1,542.58 |
| North CarolinaNorth Carolina | — | $1,431.47 |
| North DakotaNorth Dakota | — | $1,381.03 |
| NebraskaNebraska | — | $1,358.29 |
| New HampshireNew Hampshire | — | $1,517.05 |
| Northern New JerseyNew Jersey | — | $1,660.72 |
| Rest of New JerseyNew Jersey | — | $1,630.60 |
| New MexicoNew Mexico | — | $1,581.70 |
| NevadaNevada | — | $1,497.75 |
| NYC suburbs and Long Island, NYNew York | — | $1,882.79 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $1,667.39 |
| Queens, NYNew York | — | $1,768.17 |
| Rest of New YorkNew York | — | $1,452.27 |
| OhioOhio | — | $1,528.25 |
| OklahomaOklahoma | — | $1,461.29 |
| Portland, OROregon | — | $1,512.21 |
| Rest of OregonOregon | — | $1,461.29 |
| Metropolitan Philadelphia, PAPennsylvania | — | $1,623.16 |
| Rest of PennsylvaniaPennsylvania | — | $1,512.04 |
| Puerto RicoPuerto Rico | — | $1,541.18 |
| Rhode IslandRhode Island | — | $1,540.53 |
| South CarolinaSouth Carolina | — | $1,487.29 |
| South DakotaSouth Dakota | — | $1,361.93 |
| TennesseeTennessee | — | $1,398.93 |
| Austin, TXTexas | — | $1,525.53 |
| Beaumont, TXTexas | — | $1,506.10 |
| Brazoria, TXTexas | — | $1,489.92 |
| Dallas, TXTexas | — | $1,513.26 |
| Fort Worth, TXTexas | — | $1,514.84 |
| Galveston, TXTexas | — | $1,503.41 |
| Houston, TXTexas | — | $1,652.95 |
| Rest of TexasTexas | — | $1,506.65 |
| UtahUtah | — | $1,503.52 |
| VirginiaVirginia | — | $1,459.56 |
| Virgin Islands, VIUnited States Virgin Islands | — | $1,541.18 |
| VermontVermont | — | $1,406.36 |
| Rest of WashingtonWashington | — | $1,502.26 |
| King County, WAWashington | — | $1,591.40 |
| WisconsinWisconsin | — | $1,346.05 |
| West VirginiaWest Virginia | — | $1,635.05 |
| WyomingWyoming | — | $1,472.17 |
35646 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
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.
How the rate is built · 35646
RVUs × geographic indexes × conversion factor
Work32.16
32.16 RVUs× 1.000 GPCI
Practice expense5.87
5.87 RVUs× 1.000 GPCI
Malpractice8.17
8.17 RVUs× 1.000 GPCI
Adjusted RVUs
46.2000
Conversion factor
$33.4009
Medicare rate
$1,543.12
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Arkansas inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
4,388
- Code
- 35646
- Physician work
- 32.16
- Practice expense
- 5.87
- Malpractice
- 8.17
GPCI2026.csv
7
- Locality
- Arkansas
- Physician work
- 1.000
- Practice expense
- 0.859
- Malpractice
- 0.515
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 32.16 | × 1.000 | 32.1600 |
| Practice expense | 5.87 | × 0.859 | 5.0423 |
| Malpractice | 8.17 | × 0.515 | 4.2076 |
| Total RVUs | 41.4099 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Arkansas$1383.13
Facility: (32.16 × 1 + 5.87 × 0.859 + 8.17 × 0.515) × $33.4009 = $1383.13
Payment rules and modifiers for 35646
35646 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35646
Aortic bypass, to both femoral arteries
| 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 · 35646
Aortic bypass, to both femoral arteries
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
35646 without 51 · national facility
$1,543.12
Aortic bypass, to both femoral arteries
35646-51 · Second procedure: 50%
$771.56
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%).
How 35646 has changed in Arkansas
35646 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1,383.13 | RVU26D |
| 2026-07-01 | Not available in this setting | $1,383.13 | RVU26C |
| 2026-04-01 | Not available in this setting | $1,383.13 | RVU26B |
| 2026-01-01 | Not available in this setting | $1,383.13 | RVU26A |
| 2025-10-01 | Not available in this setting | $1,447.13 | RVU25D |
| 2025-07-01 | Not available in this setting | $1,447.13 | RVU25C |
| 2025-04-01 | Not available in this setting | $1,447.13 | RVU25B |
| 2025-01-01 | Not available in this setting | $1,447.13 | RVU25A |
| 2024-10-01 | Not available in this setting | $1,488.61 | RVU24D |
| 2024-07-01 | Not available in this setting | $1,488.61 | RVU24C |
| 2024-04-01 | Not available in this setting | $1,488.61 | RVU24B |
| 2024-03-09 | Not available in this setting | $1,488.61 | RVU24AR |
| 2024-01-01 | Not available in this setting | $1,464.32 | RVU24A |
| 2023-10-01 | Not available in this setting | $1,504.68 | RVU23D |
| 2023-07-01 | Not available in this setting | $1,504.68 | RVU23C |
| 2023-04-01 | Not available in this setting | $1,504.68 | RVU23B |
| 2023-01-01 | Not available in this setting | $1,504.68 | RVU23A |
| 2022-10-01 | Not available in this setting | $1,532.91 | RVU22D |
| 2022-07-01 | Not available in this setting | $1,532.91 | RVU22C |
| 2022-04-01 | Not available in this setting | $1,532.91 | RVU22B |
| 2022-01-01 | Not available in this setting | $1,532.91 | RVU22A |
| 2021-10-01 | Not available in this setting | $1,543.90 | RVU21D |
| 2021-07-01 | Not available in this setting | $1,543.90 | RVU21C |
| 2021-04-01 | Not available in this setting | $1,543.90 | RVU21B |
| 2021-01-01 | Not available in this setting | $1,543.90 | RVU21A |
| 2020-10-01 | Not available in this setting | $1,619.50 | RVU20D |
| 2020-07-01 | Not available in this setting | $1,619.50 | RVU20C |
| 2020-04-01 | Not available in this setting | $1,619.50 | RVU20B |
| 2020-01-01 | Not available in this setting | $1,619.50 | RVU20A |
| 2019-10-01 | Not available in this setting | $1,634.52 | RVU19D |
| 2019-07-01 | Not available in this setting | $1,634.52 | RVU19C |
| 2019-04-01 | Not available in this setting | $1,634.52 | RVU19B |
| 2019-01-01 | Not available in this setting | $1,634.52 | RVU19A |
| 2018-10-01 | Not available in this setting | $1,641.95 | RVU18D |
| 2018-07-01 | Not available in this setting | $1,641.95 | RVU18C |
| 2018-04-01 | Not available in this setting | $1,641.95 | RVU18B |
| 2018-01-01 | Not available in this setting | $1,641.95 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $1,642.08 | RVU17D |
| 2017-07-01 | Not available in this setting | $1,642.08 | RVU17C |
| 2017-04-01 | Not available in this setting | $1,642.08 | RVU17B |
| 2017-01-01 | Not available in this setting | $1,642.08 | RVU17A |
| 2016-10-01 | Not available in this setting | $1,647.47 | RVU16D |
| 2016-07-01 | Not available in this setting | $1,647.47 | RVU16C |
| 2016-04-01 | Not available in this setting | $1,647.47 | RVU16B |
| 2016-01-01 | Not available in this setting | $1,647.47 | RVU16A |
| 2015-10-01 | Not available in this setting | $1,652.46 | RVU15D |
| 2015-07-01 | Not available in this setting | $1,652.46 | RVU15C |
| 2015-04-01 | Not available in this setting | $1,644.23 | RVU15B |
| 2015-01-01 | Not available in this setting | $1,644.23 | RVU15A |
| 2014-10-01 | Not available in this setting | $1,644.13 | RVU14D |
| 2014-07-01 | Not available in this setting | $1,644.13 | RVU14C |
| 2014-04-01 | Not available in this setting | $1,644.13 | RVU14B |
| 2014-01-01 | Not available in this setting | $1,644.13 | RVU14A |
| 2013-10-01 | Not available in this setting | $1,596.15 | RVU13D |
| 2013-07-01 | Not available in this setting | $1,596.15 | RVU13C |
| 2013-04-01 | Not available in this setting | $1,596.15 | RVU13B |
| 2013-01-01 | Not available in this setting | $1,596.15 | RVU13AR |
Where the Arkansas rate applies
Arkansas is a Medicare payment area, not a city. Our Census mapping connects it to 626 cities and communities in Arkansas. Some span more than one payment area; confirm with the service ZIP.
- Acorn
- Adona
- Alexander
- Alicia
- Alix
- Alleene
- Allport
- Alma
35646 billing questions
How does 35646 differ from 35647?
35646 describes an aortic bypass to both femoral arteries. 35647 is the related aortofemoral code for a bypass to one femoral artery.
Does the conduit material affect code selection?
Yes. 35646 is for a conduit other than vein, typically a synthetic graft. For an aortofemoral bypass using vein, compare 35521.
Is a separate bypass code reported for each graft limb?
No. The two femoral destinations are part of the aortobifemoral bypass represented by 35646; document both distal targets in the operative report.
What documentation supports reporting 35646?
The operative report should show aortic inflow, bypass to both femoral arteries, the graft route, and use of a non-vein conduit.
How does the multiple-procedure payment rule affect another same-session procedure?
When another procedure is performed in the same session, CMS pays the highest-valued procedure in full and applies the standard 50% reduction to the others.
What are the assistant and co-surgeon payment rules?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; CMS does not permit team surgery.
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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