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Billing code 35647: Aortic bypassMedicare rate & RVUs

Open bypass from the aorta to one femoral artery using a vein conduit, typically to restore blood flow for aortoiliac occlusive disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities73 Medicare services in 2024

Medicare pays $1,359.08 for 35647 nationally in a facility.

Medicare rate · 35647

Aortic bypass

Work RVUs
28.99
Total RVUs
40.69
Global days
090

National rate · 2026

$1,359.08

Facility setting, before claim adjustments.

See every locality for 35647 →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 35647 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 35647 covers

This service covers an open surgical bypass that carries blood from the aorta to a femoral artery through a vein graft. Vascular surgeons typically perform it in a hospital operating room for severe aortoiliac occlusive disease when improved blood flow to a leg is needed. The single femoral outflow distinguishes it from a bypass supplying both femoral arteries.

Report the code when the operative record supports the aorta-to-femoral route and use of a vein conduit. Document the indication, graft material, inflow and outflow vessels, and laterality. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures at 50%. If reported bilaterally with modifier 50, payment is 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 35647 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

35647 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,233.65
Alaska*Unavailable$1,741.24
ArizonaUnavailable$1,318.96
ArkansasUnavailable$1,218.73
AtlantaUnavailable$1,414.09
AustinUnavailable$1,341.06
BakersfieldUnavailable$1,294.30
Baltimore/Surr. CntysUnavailable$1,443.75
BeaumontUnavailable$1,328.62
BrazoriaUnavailable$1,311.02

35647 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
35647 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 35647 rate is calculated

Each of 35647’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 · 35647

RVUs × geographic indexes × conversion factor

Work28.99

28.99 RVUs× 1.000 GPCI

Practice expense4.28

4.28 RVUs× 1.000 GPCI

Malpractice7.42

7.42 RVUs× 1.000 GPCI

Adjusted RVUs

40.6900

Conversion factor

$33.4009

Medicare rate

$1,359.08

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

Payment rules and modifiers for 35647

35647 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 35647

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)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 · 35647

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.

  • 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

35647 without 50 · national facility

$1,359.08

Aortic bypass

35647-50 · Bilateral: 150%

$2,038.62

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

35647 compared with similar codes

Compare codes · National

4 codes, side by side

  • 35647

    Aortic bypass28.99 wRVU

    Not priced

  • 35646

    Aortic bypass32.16 wRVU

    Not priced

  • 35637

    Aortoiliac bypass32.22 wRVU

    Not priced

  • 35638

    Aortic bypass32.76 wRVU

    Not priced

How to choose

35646Aortic bypass
Choose 35647 for a vein bypass from the aorta to one femoral artery. Code 35646 is for an aortobifemoral bypass with bilateral femoral outflow.
35637Aortoiliac bypass
Code 35637 ends at an iliac artery; this code ends at a femoral artery and uses a vein conduit.
35638Aortic bypass
Code 35638 supplies both iliac arteries. This code supplies one femoral artery through a vein bypass.

Codes related to 35647

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

Codes related to 35647
CodeHow it relatesNational office range
Used instead
35646Aortic bypassAortobifemoral bypass supplies both femoral arteries rather than one femoral target.No office rate
35637Aortoiliac bypassAortoiliac bypass is selected when the distal target is an iliac artery.No office rate
35638Aortic bypassAortobi-iliac bypass supplies both iliac arteries instead of a femoral artery.No office rate
35661Femoral bypassFemoral-femoral bypass uses a femoral inflow source rather than the aorta.No office rate

35647 billing questions

How is this different from 35646?

This code is for an aorta-to-one-femoral-artery bypass using a vein conduit. Code 35646 describes an aortobifemoral bypass, with both femoral arteries as outflow targets.

What documentation supports this code?

The operative report should identify the aortic inflow, femoral outflow, vein conduit, laterality, and reason for bypass. These details distinguish it from bypasses to iliac or other arterial targets.

Is related postoperative care separately reported?

Related postoperative care during the 90-day global period is included, along with the day-before preoperative visit.

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.

How does Medicare handle another procedure performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%. When this code is reported bilaterally with modifier 50, payment is at 150%.

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 35647PPRRVU2026_Oct_nonQPP.csv, line 4,389 (RVU26D)

Open CMS sourceHow we calculate rates

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