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Billing code 35621: Arterial bypassMedicare rate & RVUs

Reports a non-vein bypass from the axillary artery to a femoral artery, typically to restore leg blood flow when aortic reconstruction is unsuitable.

CMS RVU26DEffective Oct 1, 2026109 payment localities397 Medicare services in 2024

Medicare pays $990.34 for 35621 nationally in a facility.

Medicare rate · 35621

Arterial bypass

Swap in your local Medicare rate.

Work RVUs
20.5
Total RVUs
29.65
Global days
090

National rate · 2026

$990.34

Facility setting, before claim adjustments.

See every locality for 35621 → · 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 35621 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 35621 covers

A vascular surgeon creates an extra-anatomic route from the axillary artery to a femoral artery using a conduit other than vein, often a synthetic graft. The graft is tunneled beneath the skin and connected to the arteries to carry blood around diseased or obstructed aortoiliac segments. This operation is generally performed in a hospital operating room for patients who need lower-extremity revascularization but are not suited to direct aortic reconstruction.

Report the code when the documented bypass connects axillary inflow to a femoral target; distinguish it from grafts extending to more distal leg arteries or crossing to the opposite femoral artery. The operative report should identify the inflow and outflow vessels, conduit, laterality, and bypass configuration. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. 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 35621 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

35621 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$898.26
Alaska*Unavailable$1,262.94
ArizonaUnavailable$961.16
ArkansasUnavailable$887.27
AtlantaUnavailable$1,029.54
AustinUnavailable$979.44
BakersfieldUnavailable$947.78
Baltimore/Surr. CntysUnavailable$1,052.20
BeaumontUnavailable$966.14
BrazoriaUnavailable$956.28

35621 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
35621 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 35621 rate is calculated

Each of 35621’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 · 35621

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 20.50Practice expense 3.93Malpractice 5.22

29.6500 adjusted RVUs×$33.4009 conversion factor=$990.34

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

Payment rules and modifiers for 35621

35621 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 35621

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 · 35621

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.

  • 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

35621 without 50 · national facility

$990.34

Arterial bypass

35621-50 · Bilateral: 150%

$1,485.51

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

35621 compared with similar codes

Compare codes

35621 vs 35654 vs 35623 vs 35661 vs 35646: national Medicare rates

Swap in your local Medicare rate.

  • 35621
    Arterial bypass · 20.5 wRVU
    —
  • 35654
    Arterial bypass · 25.62 wRVU
    —
  • 35623
    Arterial bypass · 25.27 wRVU
    —
  • 35661
    Femoral bypass · 19.84 wRVU
    —
  • 35646
    Aortic bypass · 32.16 wRVU
    —

How to choose

35654Arterial bypass
35621 connects axillary inflow to a femoral artery. Choose 35654 when the configuration continues across to the opposite femoral distribution.
35623Arterial bypass
Use 35621 when the distal anastomosis is femoral; 35623 describes an axillary bypass to a popliteal or tibial artery.
35661Femoral bypass
35661 uses one femoral artery as inflow for a crossover graft to the other femoral artery. 35621 instead brings inflow from the axillary artery.
35646Aortic bypass
35646 describes an aortic-to-bilateral-femoral reconstruction. 35621 uses axillary inflow for an extra-anatomic route to a femoral artery.

Codes related to 35621

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

Codes related to 35621
CodeHow it relatesNational office range
Same family
35654Arterial bypassAdds a crossover limb to supply both femoral distributions from axillary inflow.No office rate
35623Arterial bypassUses axillary inflow but extends the bypass to a popliteal or tibial target.No office rate
Used instead
35661Femoral bypassFemoral-to-femoral bypass is an alternative route when suitable contralateral femoral inflow is available.No office rate
35646Aortic bypassAortobifemoral bypass is a direct aortic reconstruction option for bilateral femoral outflow.No office rate

35621 billing questions

When is 35621 preferred over 35654?

Use 35621 for a bypass from the axillary artery to a femoral artery. Code 35654 describes an axillary-to-femoral-femoral configuration that also supplies the opposite femoral distribution.

How does 35621 differ from an axillary-to-popliteal bypass?

The distal target determines the distinction: 35621 ends at a femoral artery, while 35623 reaches a popliteal or tibial artery.

What postoperative care is included?

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

How is bilateral performance reported?

When the bypass is performed bilaterally, modifier 50 is associated with payment at 150% under the CMS facts for this code.

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.

What operative details support reporting 35621?

Document the axillary inflow, femoral outflow, conduit type, laterality, and bypass configuration so the route can be distinguished from other extra-anatomic grafts.

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 35621PPRRVU2026_Oct_nonQPP.csv, line 4,376 (RVU26D)

Open CMS sourceHow we calculate rates

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