CPT code 35681: Composite bypass graft, one vein, one prosthetic segment2026 Medicare rate & RVUs in Missouri
Reports a composite arterial bypass graft made with one vein segment and one prosthetic segment, alongside the primary code for the bypass route.
CMS doesn’t publish an office rate for 35681 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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What 35681 covers
A vascular surgeon may construct a composite bypass when the required conduit combines one segment of vein with one segment of prosthetic graft. This configuration can be used for an arterial bypass, such as a lower-extremity bypass, when the operative plan uses both materials to create the graft. The bypass route and recipient vessels determine the primary procedure code; this code identifies the composite graft construction.
Report 35681 only with the primary bypass procedure, not by itself. The surgeon’s operative report should identify the bypass route and document that the graft comprises one vein segment and one prosthetic segment. CMS treats this as an add-on code paid within the primary procedure’s global period. Select a different composite-graft code when the documented number or type of segments differs.
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 35681 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 | $71.12 |
| Metropolitan St. Louis, MO | Unavailable | $71.53 |
| Rest of Missouri | Unavailable | $70.59 |
How the 35681 rate is calculated
Each of 35681’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 · 35681
RVUs × geographic indexes × conversion factor
Work1.56
1.56 RVUs× 1.000 GPCI
Practice expense0.19
0.19 RVUs× 1.000 GPCI
Malpractice0.40
0.40 RVUs× 1.000 GPCI
Adjusted RVUs
2.1500
Conversion factor
$33.4009
Medicare rate
$71.81
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 35681
The CMS indicators that decide how 35681 is paid alongside other services.
CMS payment indicators · 35681
Composite bypass graft, one vein, one prosthetic segment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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. |
What modifiers do to the payment
Modifier 80 · payment effect
With and without the modifier
35681 without 80 · national facility
$71.81
Composite bypass graft, one vein, one prosthetic segment
35681-80 · Assistant: 16%
$11.49
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
35681 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 35682Composite bypassTwo vein segments
- Choose 35682 when the composite graft uses two vein segments. Choose 35681 when it uses one vein segment and one prosthetic segment.
- 35683Composite bypass graftThree or more segments
- Choose 35683 when the composite graft contains three or more segments; 35681 describes the one-vein, one-prosthetic-segment configuration.
- 35656Arterial bypassFemoral to popliteal, non-vein
- 35656 identifies a femoral-popliteal bypass route. Add 35681 when the documented graft for that bypass combines one vein segment and one prosthetic segment.
35681 billing questions
Can 35681 be reported by itself?
No. It is an add-on code and must be reported with the primary procedure that identifies the bypass route.
When is 35681 appropriate instead of 35682?
Use 35681 for a composite graft with one vein segment and one prosthetic segment. Code 35682 describes a composite graft made with two vein segments.
Does 35681 identify the bypass route?
No. The primary bypass code identifies the route and target vessels; 35681 reports the graft’s one-vein, one-prosthetic-segment composition.
What should the operative report document?
Document the bypass route and the graft materials and segment arrangement, including the vein segment and prosthetic segment.
Is 35681 reported per anastomosis?
No. It represents the composite graft configuration, not a count of anastomoses.
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
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