No office rate
Use 35661 for a femoral-to-femoral bypass with femoral inflow. This code describes axillary inflow supplying both femoral arteries.
On this page
CMS RVU26D · Effective 2026-10-01
35654 Arterial bypass Medicare reimbursement rates
Reports a non-vein bypass carrying blood from an axillary artery to both femoral arteries, typically for lower-extremity revascularization when aortic inflow is unsuitable. Compare 35654 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 35654?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 35654 pays more and less
Vascular surgery
About 35654: Axillary-to-bilateral femoral bypass
Reports a non-vein bypass carrying blood from an axillary artery to both femoral arteries, typically for lower-extremity revascularization when aortic inflow is unsuitable.
A vascular surgeon creates an extra-anatomic bypass from an axillary artery to one femoral artery, with a crossover connection supplying the opposite femoral artery. The procedure uses a conduit other than vein, commonly a synthetic graft, to restore lower-extremity blood flow. It is typically performed in a hospital operating room for severe aortoiliac occlusive disease when direct aortic reconstruction is unsuitable or carries excessive risk.
Report this code when the operative record supports the axillary inflow, both femoral outflow connections, and use of a non-vein graft. The record should identify the indication, graft route and configuration, and the vessels treated. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate for this already bilateral configuration. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 35654
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU25.62 · 69%
- Practice expense (office) RVU4.88 · 13%
- Malpractice RVU6.52 · 18%
647
Medicare services in 2024 · #3334 by national volume
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.
35654 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
Use 35646 for an aortobifemoral bypass with aortic inflow. This code describes an extra-anatomic route from the axillary artery.
No office rate
Use 35623 when the axillary bypass outflow is to a popliteal or tibial artery, rather than to both femoral arteries.
See how rates vary across the country
35654 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Compare 35654 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $1121.61 |
| Alaska* | Office Unavailable | Facility $1577.18 |
| Arizona | Office Unavailable | Facility $1200.09 |
| Arkansas | Office Unavailable | Facility $1107.90 |
| Atlanta | Office Unavailable | Facility $1285.45 |
| Austin | Office Unavailable | Facility $1222.84 |
| Bakersfield | Office Unavailable | Facility $1183.26 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $1313.70 |
| Beaumont | Office Unavailable | Facility $1206.37 |
| Brazoria | Office Unavailable | Facility $1193.97 |
| Chicago | Office Unavailable | Facility $1525.32 |
| Chico | Office Unavailable | Facility $1165.65 |
| Colorado | Office Unavailable | Facility $1209.51 |
| Connecticut | Office Unavailable | Facility $1311.90 |
| Dallas | Office Unavailable | Facility $1212.63 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $1336.33 |
| Delaware | Office Unavailable | Facility $1216.83 |
| Detroit | Office Unavailable | Facility $1380.19 |
| East St. Louis | Office Unavailable | Facility $1444.28 |
| El Centro | Office Unavailable | Facility $1166.74 |
| Fort Lauderdale | Office Unavailable | Facility $1414.58 |
| Fort Worth | Office Unavailable | Facility $1213.83 |
| Fresno | Office Unavailable | Facility $1165.65 |
| Galveston | Office Unavailable | Facility $1204.75 |
| Hanford-Corcoran | Office Unavailable | Facility $1165.65 |
| Hawaii, Guam | Office Unavailable | Facility $1167.15 |
| Houston | Office Unavailable | Facility $1324.09 |
| Idaho | Office Unavailable | Facility $1108.69 |
| Indiana | Office Unavailable | Facility $1112.67 |
| Iowa | Office Unavailable | Facility $1091.33 |
| Kansas | Office Unavailable | Facility $1112.84 |
| Kentucky | Office Unavailable | Facility $1199.90 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1228.24 |
| Madera | Office Unavailable | Facility $1165.65 |
| Manhattan | Office Unavailable | Facility $1445.29 |
| Merced | Office Unavailable | Facility $1165.65 |
| Metropolitan Boston | Office Unavailable | Facility $1279.25 |
| Metropolitan Kansas City | Office Unavailable | Facility $1221.55 |
| Metropolitan Philadelphia | Office Unavailable | Facility $1300.62 |
| Metropolitan St. Louis | Office Unavailable | Facility $1229.11 |
| Miami | Office Unavailable | Facility $1576.16 |
| Minnesota | Office Unavailable | Facility $1087.92 |
| Mississippi | Office Unavailable | Facility $1157.01 |
| Modesto | Office Unavailable | Facility $1165.65 |
| Montana** | Office Unavailable | Facility $1236.07 |
| Napa | Office Unavailable | Facility $1235.10 |
| Nebraska | Office Unavailable | Facility $1088.50 |
| Nevada** | Office Unavailable | Facility $1200.30 |
| New Hampshire | Office Unavailable | Facility $1215.96 |
| New Mexico | Office Unavailable | Facility $1266.75 |
| New Orleans | Office Unavailable | Facility $1256.50 |
| North Carolina | Office Unavailable | Facility $1146.96 |
| North Dakota** | Office Unavailable | Facility $1107.14 |
| Northern Nj | Office Unavailable | Facility $1331.30 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $1508.71 |
| Ohio | Office Unavailable | Facility $1224.06 |
| Oklahoma | Office Unavailable | Facility $1170.50 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1208.03 |
| Portland | Office Unavailable | Facility $1212.54 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $1336.23 |
| Puerto Rico | Office Unavailable | Facility $1235.03 |
| Queens | Office Unavailable | Facility $1417.19 |
| Redding | Office Unavailable | Facility $1165.65 |
| Rest Of California | Office Unavailable | Facility $1165.65 |
| Rest Of Florida | Office Unavailable | Facility $1338.87 |
| Rest Of Georgia | Office Unavailable | Facility $1260.71 |
| Rest Of Illinois | Office Unavailable | Facility $1344.93 |
| Rest Of Louisiana | Office Unavailable | Facility $1208.61 |
| Rest Of Maine | Office Unavailable | Facility $1141.14 |
| Rest Of Maryland | Office Unavailable | Facility $1229.16 |
| Rest Of Massachusetts | Office Unavailable | Facility $1214.62 |
| Rest Of Michigan | Office Unavailable | Facility $1250.41 |
| Rest Of Missouri | Office Unavailable | Facility $1208.35 |
| Rest Of New Jersey | Office Unavailable | Facility $1306.85 |
| Rest Of New York | Office Unavailable | Facility $1163.67 |
| Rest Of Oregon | Office Unavailable | Facility $1171.17 |
| Rest Of Pennsylvania | Office Unavailable | Facility $1211.16 |
| Rest Of Texas | Office Unavailable | Facility $1207.06 |
| Rest Of Washington | Office Unavailable | Facility $1204.22 |
| Rhode Island | Office Unavailable | Facility $1234.62 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1235.54 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1192.83 |
| Salinas | Office Unavailable | Facility $1187.90 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1194.38 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1266.81 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1259.40 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1301.63 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1271.36 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1172.66 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1188.47 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1186.47 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1198.29 |
| Seattle (King Cnty) | Office Unavailable | Facility $1276.44 |
| South Carolina | Office Unavailable | Facility $1191.45 |
| South Dakota** | Office Unavailable | Facility $1091.90 |
| Southern Maine | Office Unavailable | Facility $1154.68 |
| Stockton | Office Unavailable | Facility $1165.65 |
| Suburban Chicago | Office Unavailable | Facility $1415.01 |
| Tennessee | Office Unavailable | Facility $1120.84 |
| Utah | Office Unavailable | Facility $1204.51 |
| Vallejo | Office Unavailable | Facility $1224.43 |
| Vermont | Office Unavailable | Facility $1127.29 |
| Virgin Islands | Office Unavailable | Facility $1235.03 |
| Virginia | Office Unavailable | Facility $1169.70 |
| Visalia | Office Unavailable | Facility $1165.65 |
| West Virginia | Office Unavailable | Facility $1309.01 |
| Wisconsin | Office Unavailable | Facility $1078.96 |
| Wyoming** | Office Unavailable | Facility $1179.88 |
| Yuba City | Office Unavailable | Facility $1165.65 |
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35654 billing questions
How does this differ from 35661?
This procedure uses axillary inflow and supplies both femoral arteries. Code 35661 describes a femoral-to-femoral bypass, with inflow from a femoral artery.
Should modifier 50 be appended?
No. The axillary-to-femoral-femoral configuration already describes bypass to both femoral arteries, and bilateral adjustment is inappropriate.
What should the operative report document?
Document the axillary inflow, each femoral connection, the graft configuration and conduit type, and the clinical indication for revascularization.
How does the global period affect postoperative visits?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can this be reported with another procedure performed in the same session?
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 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,38835646,,Bpg aortobifemoral,A,,32.16,5.87,NA,5.87,,8.17,46.20,46.20,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,38935647,,Bpg aortofemoral,A,,28.99,4.28,NA,4.28,,7.42,40.69,40.69,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,39035650,,Bpg axillary-axillary,A,,19.66,3.20,NA,3.20,,5.02,27.88,27.88,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,39135654,,Bpg axillary-femoral-femoral,A,,25.62,4.88,NA,4.88,,6.52,37.02,37.02,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,39235656,,Bpg femoral-popliteal,A,,19.96,4.07,NA,4.07,,5.07,29.10,29.10,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,39335661,,Bpg femoral-femoral,A,,19.84,4.53,NA,4.53,,5.04,29.41,29.41,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,39435663,,Bpg ilioiliac,A,,23.33,3.93,NA,3.93,,5.97,33.23,33.23,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00