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Billing code 35521: Arterial bypassMedicare rate & RVUs

Reports an open arterial bypass using vein from the axillary artery to one femoral artery to route blood around obstructed aortoiliac vessels.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,118.93 for 35521 nationally in a facility.

Medicare rate · 35521

Arterial bypass

Work RVUs
23.53
Total RVUs
33.50
Global days
090

National rate · 2026

$1,118.93

Facility setting, before claim adjustments.

See every locality for 35521 →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 35521 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 35521 covers

A vascular surgeon creates an extra-anatomic route from the axillary artery to a femoral artery using a vein conduit. This can restore lower-extremity blood flow when severe aortoiliac occlusive disease makes a direct aortic reconstruction unsuitable. The operation is performed in an operating room and includes the graft route and its arterial connections. The code identifies a single femoral outflow; a reconstruction branching to both femoral arteries is a different service.

Select the code when the operative report supports an axillary inflow, one femoral target, and a vein conduit. Document the bypass path, target artery, conduit, and laterality. The service has 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 at 50%. Bilateral reporting with modifier 50 is paid at 150%. 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 35521 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

35521 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,015.17
Alaska*Unavailable$1,430.19
ArizonaUnavailable$1,085.89
ArkansasUnavailable$1,002.81
AtlantaUnavailable$1,163.81
AustinUnavailable$1,105.23
BakersfieldUnavailable$1,067.91
Baltimore/Surr. CntysUnavailable$1,188.79
BeaumontUnavailable$1,092.78
BrazoriaUnavailable$1,079.79

35521 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
35521 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 35521 rate is calculated

Each of 35521’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 · 35521

RVUs × geographic indexes × conversion factor

Work23.53

23.53 RVUs× 1.000 GPCI

Practice expense3.95

3.95 RVUs× 1.000 GPCI

Malpractice6.02

6.02 RVUs× 1.000 GPCI

Adjusted RVUs

33.5000

Conversion factor

$33.4009

Medicare rate

$1,118.93

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

Payment rules and modifiers for 35521

35521 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 35521

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 · 35521

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

35521 without 50 · national facility

$1,118.93

Arterial bypass

35521-50 · Bilateral: 150%

$1,678.40

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

35521 compared with similar codes

Compare codes · National

4 codes, side by side

  • 35521

    Arterial bypass23.53 wRVU

    Not priced

  • 35621

    Arterial bypass20.5 wRVU

    Not priced

  • 35533

    Arterial bypass29.17 wRVU

    Not priced

  • 35539

    Aortic bypass43.01 wRVU

    Not priced

How to choose

35621Arterial bypass
The route and single femoral target are the same, but 35621 is for a conduit other than vein; 35521 is for a vein conduit.
35533Arterial bypass
Use 35533 when the axillary-to-femoral vein bypass branches to both femoral arteries. 35521 describes a single femoral outflow.
35539Aortic bypass
Both involve a vein bypass to a femoral artery, but 35539 uses aortic inflow; 35521 uses axillary inflow.

Codes related to 35521

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

Codes related to 35521
CodeHow it relatesNational office range
Used instead
35621Arterial bypassSame axillary-to-femoral route using a conduit other than vein.No office rate
35539Aortic bypassVein bypass to the femoral artery using aortic rather than axillary inflow.No office rate
Same family
35533Arterial bypassVein bypass from the axillary artery branching to both femoral arteries.No office rate
35646Aortic bypassAxillary-to-both-femoral bypass using a conduit other than vein.No office rate

35521 billing questions

When should 35521 be selected instead of 35621?

Use 35521 for an axillary-to-femoral bypass using a vein conduit. Code 35621 is the corresponding axillary-to-femoral bypass using a conduit other than vein.

Does 35521 describe a bypass to both femoral arteries?

No. It describes one femoral outflow. A single axillary inflow graft that branches to both femoral arteries is represented by 35533 when performed with vein.

What operative details support reporting 35521?

Document the axillary inflow, the femoral target and laterality, the vein conduit, and the bypass route. The report should make clear whether the graft reaches one femoral artery or branches to both.

How does the 90-day global period affect follow-up billing?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period. The bypass is major surgery under the CMS facts for this code.

How does Medicare treat bilateral reporting and surgical assistance?

A bilateral procedure reported with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeons require supporting documentation, and 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 35521PPRRVU2026_Oct_nonQPP.csv, line 4,343 (RVU26D)

Open CMS sourceHow we calculate rates

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