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Billing code 35540: Aortic bypassMedicare rate & RVUs

Reports open reconstruction carrying blood from the aorta to both femoral arteries when the surgeon uses an autogenous vein conduit.

CMS RVU26DEffective Oct 1, 2026109 payment localities12 Medicare services in 2024

Medicare pays $2,216.48 for 35540 nationally in a facility.

Medicare rate · 35540

Aortic bypass

Swap in your local Medicare rate.

Work RVUs
48.1
Total RVUs
66.36
Global days
090

National rate · 2026

$2,216.48

Facility setting, before claim adjustments.

See every locality for 35540 → · 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 35540 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 35540 covers

A vascular surgeon creates a route from the aorta to the right and left femoral arteries using the patient’s own vein as the graft. The operation is used to restore lower-extremity blood flow in selected patients with extensive aortoiliac occlusive disease. It is performed in an operating room, generally in a hospital facility; the specific vein source and graft configuration depend on the operative plan.

Report this code when the documented bypass has an aortic inflow, two femoral outflows, and an autogenous vein conduit. The operative report should identify the graft material and the bypass endpoints. The 90-day global period includes 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. The bifemoral targets are represented by this single code; modifier 50 is not added merely because the graft reaches both sides. Assistant-at-surgery payment is restricted, co-surgeons require 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 35540 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

35540 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,012.99
Alaska*Unavailable$2,847.74
ArizonaUnavailable$2,151.04
ArkansasUnavailable$1,988.82
AtlantaUnavailable$2,307.25
AustinUnavailable$2,184.24
BakersfieldUnavailable$2,105.00
Baltimore/Surr. CntysUnavailable$2,354.25
BeaumontUnavailable$2,169.42
BrazoriaUnavailable$2,136.95

35540 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
35540 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 35540 rate is calculated

Each of 35540’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 · 35540

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 48.10Practice expense 5.93Malpractice 12.33

66.3600 adjusted RVUs×$33.4009 conversion factor=$2,216.48

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 35540

35540 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 35540

Aortic 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)1Not paid (statutory restriction).
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 · 35540

Aortic 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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

35540 without 50 · national facility

$2,216.48

Aortic bypass

35540-50 · Bilateral: 150%

$3,324.72

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

35540 compared with similar codes

Compare codes

35540 vs 35646 vs 35539 vs 35538 vs 35521: national Medicare rates

Swap in your local Medicare rate.

  • 35540
    Aortic bypass · 48.1 wRVU
    —
  • 35646
    Aortic bypass · 32.16 wRVU
    —
  • 35539
    Aortic bypass · 43.01 wRVU
    —
  • 35538
    Aortic bypass · 45.85 wRVU
    —
  • 35521
    Arterial bypass · 23.53 wRVU
    —

How to choose

35646Aortic bypass
Both codes describe an aorta-to-both-femoral bypass route. Choose based on conduit: 35540 is for vein, while 35646 is for a conduit other than vein.
35539Aortic bypass
This code is for an aortic bypass to a femoral artery; 35540 describes outflow to both femoral arteries.
35538Aortic bypass
This code routes the aortic bypass to both iliac arteries. 35540 has femoral rather than iliac outflows.
35521Arterial bypass
This code uses an axillary inflow for a bypass to the femoral artery. 35540 uses the aorta as inflow and reaches both femoral arteries.

Codes related to 35540

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

Codes related to 35540
CodeHow it relatesNational office range
Used instead
35646Aortic bypassAortobifemoral bypass using a conduit other than vein.No office rate
35521Arterial bypassExtra-anatomic axillary-to-femoral bypass provides a different route to lower-extremity revascularization.No office rate
Same family
35539Aortic bypassAortic bypass to a femoral artery rather than both femoral arteries.No office rate
35538Aortic bypassAortic bypass to both iliac arteries rather than the femoral arteries.No office rate

35540 billing questions

When is 35540 preferred over 35646?

Use 35540 when the aorta-to-both-femoral bypass uses the patient’s vein. Code 35646 describes the same general route when the conduit is other than vein.

Does the bifemoral graft require modifier 50?

No. The single code describes the aortic bypass to both femoral arteries, so the two outflow targets alone do not call for modifier 50.

How does the 90-day global period affect postoperative visits?

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

What should the operative report establish?

Document the aortic inflow, both femoral outflows, and use of the patient’s vein as the bypass conduit.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment is subject to a statutory restriction. Co-surgeons are payable only with supporting documentation; team surgery is not permitted.

How are other procedures from the same session paid?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.

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 35540PPRRVU2026_Oct_nonQPP.csv, line 4,356 (RVU26D)

Open CMS sourceHow we calculate rates

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