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Billing code 37605: Carotid ligationMedicare rate & RVUs

Surgical ligation of an internal or common carotid artery is reported when the surgeon ties off the vessel for a selected vascular or bleeding problem.

CMS RVU26DEffective Oct 1, 2026109 payment localities47 Medicare services in 2024

Medicare pays $675.37 for 37605 nationally in a facility.

Medicare rate · 37605

Carotid ligation

Swap in your local Medicare rate.

Work RVUs
13.92
Total RVUs
20.22
Global days
090

National rate · 2026

$675.37

Facility setting, before claim adjustments.

See every locality for 37605 → · 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 37605 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 37605 covers

The surgeon exposes and ties off an internal or common carotid artery, interrupting flow through the treated vessel. This uncommon open neck operation may be performed for selected carotid injury, uncontrolled bleeding, or an aneurysm when vessel ligation is the intended treatment. Vascular, trauma, or head-and-neck surgeons may perform it in an operating room, generally in a facility setting.

Report 37605 when the operative note supports ligation of the internal or common carotid artery; document the specific artery and the procedure performed. Distinguish the external carotid ligation code and the related carotid code whose descriptor specifies occlusion. The day-before preoperative visit and 90 days of related postoperative care are included in the 90-day global period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this descriptor and anatomy. 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 37605 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

37605 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$612.32
Alaska*Unavailable$860.40
ArizonaUnavailable$655.41
ArkansasUnavailable$604.79
AtlantaUnavailable$702.13
AustinUnavailable$668.05
BakersfieldUnavailable$646.49
Baltimore/Surr. CntysUnavailable$717.67
BeaumontUnavailable$658.69
BrazoriaUnavailable$652.10

37605 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
37605 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 37605 rate is calculated

Each of 37605’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 · 37605

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 13.92Practice expense 2.74Malpractice 3.56

20.2200 adjusted RVUs×$33.4009 conversion factor=$675.37

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

Payment rules and modifiers for 37605

37605 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 37605

Carotid ligation

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)0The 150% bilateral adjustment doesn’t apply.
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 · 37605

Carotid ligation

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 51 · payment effect

With and without the modifier

37605 without 51 · national facility

$675.37

Carotid ligation

37605-51 · Second procedure: 50%

$337.69

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

37605 compared with similar codes

Compare codes

37605 vs 37600 vs 37606 vs 35301: national Medicare rates

Swap in your local Medicare rate.

  • 37605
    Carotid ligation · 13.92 wRVU
    —
  • 37600
    Carotid ligation · 12.11 wRVU
    —
  • 37606
    Carotid ligation · 8.59 wRVU
    —
  • 35301
    Arterial endarterectomy · 20.63 wRVU
    —

How to choose

37600Carotid ligation
This code concerns the internal or common carotid artery; 37600 is for the external carotid artery.
37606Carotid ligation
Both concern internal or common carotid ligation, but 37606 specifies occlusion. The operative documentation must support the descriptor selected.
35301Arterial endarterectomy
35301 describes carotid endarterectomy, which removes obstructive material from the artery; 37605 is reported for tying off the artery.

Codes related to 37605

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

Codes related to 37605
CodeHow it relatesNational office range
Used instead
37600Carotid ligationUsed for ligation of the external carotid artery rather than the internal or common carotid.No office rate
37615Arterial ligationCovers ligation of a major neck artery when the treated vessel and procedure fit that code.No office rate
Same family
37606Carotid ligationRelated internal or common carotid ligation code with occlusion specified in its descriptor.No office rate

37605 billing questions

How is 37605 distinguished from 37600?

37605 is for ligation of the internal or common carotid artery. Use 37600 when the external carotid artery is the vessel ligated.

When should 37606 be considered instead?

The 37606 descriptor specifies occlusion with internal or common carotid artery ligation. Select it only when the operative documentation supports that added descriptor detail.

Can modifier 50 be reported for both sides?

No. The descriptor and anatomy make modifier 50 inappropriate for bilateral adjustment.

What postoperative care is included?

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

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.

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 37605PPRRVU2026_Oct_nonQPP.csv, line 4,673 (RVU26D)

Open CMS sourceHow we calculate rates

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