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Billing code 35518: Arterial bypassMedicare rate & RVUs

Reports open graft bypass from one axillary artery to the other, commonly routing blood around an obstructed subclavian artery.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,038.43 for 35518 nationally in a facility.

Medicare rate · 35518

Arterial bypass

Work RVUs
22.08
Total RVUs
31.09
Global days
090

National rate · 2026

$1,038.43

Facility setting, before claim adjustments.

See every locality for 35518 →Billed by an NP, PA or therapist? →

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 10 sections
  1. Medicare rate
  2. What 35518 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 35518 covers

A vascular surgeon creates an extra-anatomic route between the axillary arteries, typically across the chest, to improve blood flow when the usual arterial pathway is obstructed. This operation is commonly considered for symptomatic subclavian artery occlusive disease when the axillary arteries provide suitable inflow and outflow. The graft may be prosthetic or another documented conduit; the operative report should identify its route and both anastomotic vessels.

Choose this code when the bypass runs from axillary artery to axillary artery, rather than from a subclavian artery or to an arm or leg artery. The 90-day global period includes the day-before preoperative visit and related postoperative care through day 90. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 pricing is 150% for a bilateral procedure. 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 35518 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

35518 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$942.71
Alaska*Unavailable$1,330.08
ArizonaUnavailable$1,007.86
ArkansasUnavailable$931.31
AtlantaUnavailable$1,080.25
AustinUnavailable$1,025.02
BakersfieldUnavailable$989.76
Baltimore/Surr. CntysUnavailable$1,103.04
BeaumontUnavailable$1,014.92
BrazoriaUnavailable$1,001.95

35518 rates by state

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

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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
35518 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 35518 rate is calculated

Each of 35518’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 · 35518

RVUs × geographic indexes × conversion factor

Work22.08

22.08 RVUs× 1.000 GPCI

Practice expense3.38

3.38 RVUs× 1.000 GPCI

Malpractice5.63

5.63 RVUs× 1.000 GPCI

Adjusted RVUs

31.0900

Conversion factor

$33.4009

Medicare rate

$1,038.43

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 35518

35518 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 35518

Arterial bypass

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.84/0.07Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 35518

Arterial bypass

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

35518 without 50 · national facility

$1,038.43

Arterial bypass

35518-50 · Bilateral: 150%

$1,557.65

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).

When to use modifier 50

35518 compared with similar codes

Compare codes · National

5 codes, side by side

  • 35518

    Arterial bypass22.08 wRVU

    Not priced

  • 35516

    Arterial bypass23.6 wRVU

    Not priced

  • 35511

    Artery bypass21.65 wRVU

    Not priced

  • 35521

    Arterial bypass23.53 wRVU

    Not priced

  • 35522

    Arterial bypass22.57 wRVU

    Not priced

How to choose

35516Arterial bypass
Choose 35518 when the graft connects the two axillary arteries. Choose 35516 when the bypass runs from a subclavian artery to an axillary artery.
35511Artery bypass
35511 describes a subclavian-to-subclavian route. This code requires axillary arteries as both bypass endpoints.
35521Arterial bypass
35521 routes blood from an axillary artery to a femoral artery. This code connects one axillary artery to the other.
35522Arterial bypass
35522 ends at a brachial artery. Use this code when the bypass outflow is the opposite axillary artery.

Codes related to 35518

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 35518
CodeHow it relatesNational office range
Same family
35516Arterial bypassSubclavian-to-axillary bypass; differs at the inflow vessel.No office rate
35511Artery bypassSubclavian-to-subclavian bypass, with different graft endpoints.No office rate
35521Arterial bypassAxillary-to-femoral bypass, extending the outflow to a leg artery.No office rate
35522Arterial bypassAxillary-to-brachial bypass, with brachial rather than axillary outflow.No office rate

35518 billing questions

How do I distinguish this from a subclavian-to-axillary bypass?

Use this code when both bypass endpoints are axillary arteries. A bypass beginning at a subclavian artery and ending at an axillary artery is a different configuration.

What operative documentation supports this code?

Document the bypass indication, the donor and recipient arteries, the graft route, and the conduit used. The record should make clear that the graft connects axillary artery to axillary artery.

Does the 90-day global include postoperative visits?

Yes. The day-before preoperative visit and related postoperative care through 90 days are included in the global period.

How is this code priced with other procedures in the same session?

The highest-valued procedure is paid in full, and other procedures are paid at 50%. For a bilateral procedure reported with modifier 50, the CMS pricing rule is 150%.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; 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
RVUs for 35518PPRRVU2026_Oct_nonQPP.csv, line 4,341 (RVU26D)

Open CMS sourceHow we calculate rates

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