FeeBase
Log inGet started
Menu

Billing code 35691: Arterial transpositionMedicare rate & RVUs

Reports surgical relocation of a vertebral artery to the carotid artery to restore blood flow in selected patients with vertebral artery disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities48 Medicare services in 2024

Medicare pays $863.08 for 35691 nationally in a facility.

Medicare rate · 35691

Arterial transposition

Swap in your local Medicare rate.

Work RVUs
17.95
Total RVUs
25.84
Global days
090

National rate · 2026

$863.08

Facility setting, before claim adjustments.

See every locality for 35691 → · 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 35691 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 35691 covers

A vascular surgeon mobilizes the vertebral artery and reconnects it directly to the carotid artery, routing blood around a diseased proximal segment without creating a separate bypass conduit. The operation is performed in the neck, typically in a hospital operating room, for selected patients with symptomatic vertebral artery occlusive disease affecting blood flow to the posterior circulation.

Report this code when the operative work is a direct vertebral-to-carotid transposition, rather than a bypass between those vessels. The operative report should identify the vessels and side, describe the transposition and anastomosis, and support the clinical indication. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral procedures, modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. 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 35691 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

35691 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$782.87
Alaska*Unavailable$1,101.35
ArizonaUnavailable$837.62
ArkansasUnavailable$773.30
AtlantaUnavailable$897.40
AustinUnavailable$853.25
BakersfieldUnavailable$825.27
Baltimore/Surr. CntysUnavailable$917.00
BeaumontUnavailable$842.27
BrazoriaUnavailable$833.23

35691 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
35691 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 35691 rate is calculated

Each of 35691’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 · 35691

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 17.95Practice expense 3.31Malpractice 4.58

25.8400 adjusted RVUs×$33.4009 conversion factor=$863.08

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

Payment rules and modifiers for 35691

35691 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 35691

Arterial transposition

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 · 35691

Arterial transposition

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

35691 without 50 · national facility

$863.08

Arterial transposition

35691-50 · Bilateral: 150%

$1,294.62

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

35691 compared with similar codes

Compare codes

35691 vs 35642 vs 35645 vs 35694 vs 35695: national Medicare rates

Swap in your local Medicare rate.

  • 35691
    Arterial transposition · 17.95 wRVU
    —
  • 35642
    Arterial bypass · 18.47 wRVU
    —
  • 35645
    Arterial bypass · 17.97 wRVU
    —
  • 35694
    Artery transposition · 18.8 wRVU
    —
  • 35695
    Arterial transposition · 19.56 wRVU
    —

How to choose

35642Arterial bypass
35691 directly transposes the vertebral artery to the carotid artery. 35642 describes a carotid-vertebral bypass rather than direct relocation.
35645Arterial bypass
35691 connects the vertebral artery directly to the carotid artery; 35645 describes a bypass from the subclavian artery to the vertebral artery.
35694Artery transposition
35691 transposes the vertebral artery to the carotid artery. 35694 concerns transposition of the subclavian artery to the carotid artery.
35695Arterial transposition
35691 is a vertebral-to-carotid transposition; 35695 transposes the carotid artery to the subclavian artery.

Codes related to 35691

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

Codes related to 35691
CodeHow it relatesNational office range
Used instead
35642Arterial bypassCarotid-to-vertebral bypass, rather than direct vertebral artery transposition.No office rate
35645Arterial bypassSubclavian-to-vertebral bypass when the operation creates that bypass.No office rate
Same family
35693Arterial transpositionTransposition of a subclavian artery; the artery and recipient anatomy differ.No office rate
35694Artery transpositionSubclavian-to-carotid transposition, with different source artery anatomy.No office rate
35695Arterial transpositionCarotid-to-subclavian transposition, with the direction and vessels reversed.No office rate

35691 billing questions

When is 35691 appropriate instead of a carotid-vertebral bypass?

Use 35691 when the vertebral artery is directly transposed and reconnected to the carotid artery. A separate bypass between the vessels is reported with the applicable bypass code, such as 35642.

Does 35691 describe a bypass graft?

No. It describes direct relocation and reconnection of the vertebral artery; it is not the code for constructing a separate graft bypass.

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 a bilateral procedure handled?

CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%.

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.

What operative details support code selection?

Document the vertebral and carotid vessels, the side, the direct transposition and reconnection, and the clinical reason for revascularization.

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 35691PPRRVU2026_Oct_nonQPP.csv, line 4,403 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 35691 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 35691 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →