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Billing code 35666: Leg bypassMedicare rate & RVUs

Reports a lower-extremity bypass using a nonvein graft from a femoral artery to an anterior tibial, posterior tibial, or peroneal artery.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.7K Medicare services in 2024

Medicare pays $1,167.70 for 35666 nationally in a facility.

Medicare rate · 35666

Leg bypass

Swap in your local Medicare rate.

Work RVUs
23.07
Total RVUs
34.96
Global days
090

National rate · 2026

$1,167.70

Facility setting, before claim adjustments.

See every locality for 35666 → · 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 35666 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 35666 covers

A vascular surgeon creates a bypass from a femoral artery to an anterior tibial, posterior tibial, or peroneal artery using a graft other than vein. This distal revascularization is used to route blood around obstructive disease in the leg, commonly in limb-salvage surgery for severe peripheral arterial disease. The operation is generally performed in a hospital operating room; the operative report identifies the bypass origin, distal target, and graft material.

Choose this code when the documented inflow is femoral, the outflow is one of the specified tibial or peroneal arteries, and the conduit is not vein. The code has a 90-day global period, including 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 other procedures are subject to a 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with 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 35666 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

35666 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,057.26
Alaska*Unavailable$1,477.67
ArizonaUnavailable$1,133.15
ArkansasUnavailable$1,044.02
AtlantaUnavailable$1,212.76
AustinUnavailable$1,158.43
BakersfieldUnavailable$1,124.65
Baltimore/Surr. CntysUnavailable$1,241.28
BeaumontUnavailable$1,135.69
BrazoriaUnavailable$1,128.78

35666 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
35666 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 35666 rate is calculated

Each of 35666’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 · 35666

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 23.07Practice expense 6.00Malpractice 5.89

34.9600 adjusted RVUs×$33.4009 conversion factor=$1,167.70

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

Payment rules and modifiers for 35666

35666 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 35666

Leg 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 · 35666

Leg 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

35666 without 50 · national facility

$1,167.70

Leg bypass

35666-50 · Bilateral: 150%

$1,751.55

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

35666 compared with similar codes

Compare codes

35666 vs 35566 vs 35671 vs 35656: national Medicare rates

Swap in your local Medicare rate.

  • 35666
    Leg bypass · 23.07 wRVU
    —
  • 35566
    Leg bypass · 31.54 wRVU
    —
  • 35671
    Leg bypass · 20.25 wRVU
    —
  • 35656
    Arterial bypass · 19.96 wRVU
    —

How to choose

35566Leg bypass
The bypass origin and distal targets are the same, but 35566 is for a vein graft; 35666 is for a graft other than vein.
35671Leg bypass
Both codes describe bypasses to tibial or peroneal targets using a nonvein graft. Choose 35666 for femoral inflow and 35671 for popliteal inflow.
35656Arterial bypass
This code describes a nonvein bypass from the femoral artery to the popliteal artery, rather than to one of the more distal targets covered by 35666.

Codes related to 35666

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

Codes related to 35666
CodeHow it relatesNational office range
Used instead
35566Leg bypassSame femoral-to-tibial or peroneal route when the bypass uses a vein graft.No office rate
35671Leg bypassUses popliteal rather than femoral inflow for a bypass to tibial or peroneal arteries.No office rate
35656Arterial bypassFemoral-to-popliteal bypass when the distal target is the popliteal artery.No office rate

35666 billing questions

When should 35666 be chosen instead of 35566?

Use 35666 for the specified femoral-to-tibial or peroneal bypass when the graft is other than vein. Use 35566 for the same route when a vein graft is used.

Which details should the operative report support?

Document the femoral inflow artery, the anterior tibial, posterior tibial, or peroneal outflow target, and the graft material. These details distinguish 35666 from bypass codes with another origin, destination, or conduit.

How is bilateral surgery reported?

For bilateral procedures, report modifier 50; CMS pays the procedure at 150%.

How does the multiple-procedure reduction affect 35666?

When other procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are paid at 50%.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.

What postoperative care is included?

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

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 35666PPRRVU2026_Oct_nonQPP.csv, line 4,396 (RVU26D)

Open CMS sourceHow we calculate rates

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