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 in Delaware
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$1216.83
Base rate per service
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.
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 rates for Delaware, 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.
The same code, a different location
How does Delaware compare?
35654 across payment areas
Same release and payment basis · bars start at $0
Delaware · This locality
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Alabama
Alabama · 35654
Office
Unavailable
Facility
$1121.61
No comparable office rate is available.
Arkansas
Arkansas · 35654
Office
Unavailable
Facility
$1107.90
No comparable office rate is available.
Arizona
Arizona · 35654
Office
Unavailable
Facility
$1200.09
No comparable office rate is available.
Bakersfield
California · 35654
Office
Unavailable
Facility
$1183.26
No comparable office rate is available.
Chico
California · 35654
Office
Unavailable
Facility
$1165.65
No comparable office rate is available.
El Centro
California · 35654
Office
Unavailable
Facility
$1166.74
No comparable office rate is available.
Fresno
California · 35654
Office
Unavailable
Facility
$1165.65
No comparable office rate is available.
Hanford-Corcoran
California · 35654
Office
Unavailable
Facility
$1165.65
No comparable office rate is available.
Madera
California · 35654
Office
Unavailable
Facility
$1165.65
No comparable office rate is available.
Merced
California · 35654
Office
Unavailable
Facility
$1165.65
No comparable office rate is available.
Modesto
California · 35654
Office
Unavailable
Facility
$1165.65
No comparable office rate is available.
Napa
California · 35654
Office
Unavailable
Facility
$1235.10
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 35654
Office
Unavailable
Facility
$1208.03
No comparable office rate is available.
Redding
California · 35654
Office
Unavailable
Facility
$1165.65
No comparable office rate is available.
Rest Of California
California · 35654
Office
Unavailable
Facility
$1165.65
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 35654
Office
Unavailable
Facility
$1235.54
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 35654
Office
Unavailable
Facility
$1192.83
No comparable office rate is available.
Salinas
California · 35654
Office
Unavailable
Facility
$1187.90
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 35654
Office
Unavailable
Facility
$1194.38
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 35654
Office
Unavailable
Facility
$1266.81
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 35654
Office
Unavailable
Facility
$1259.40
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 35654
Office
Unavailable
Facility
$1301.63
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 35654
Office
Unavailable
Facility
$1271.36
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 35654
Office
Unavailable
Facility
$1172.66
No comparable office rate is available.
Santa Cruz-Watsonville
California · 35654
Office
Unavailable
Facility
$1188.47
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 35654
Office
Unavailable
Facility
$1186.47
No comparable office rate is available.
Santa Rosa-Petaluma
California · 35654
Office
Unavailable
Facility
$1198.29
No comparable office rate is available.
Stockton
California · 35654
Office
Unavailable
Facility
$1165.65
No comparable office rate is available.
Vallejo
California · 35654
Office
Unavailable
Facility
$1224.43
No comparable office rate is available.
Visalia
California · 35654
Office
Unavailable
Facility
$1165.65
No comparable office rate is available.
Yuba City
California · 35654
Office
Unavailable
Facility
$1165.65
No comparable office rate is available.
Colorado
Colorado · 35654
Office
Unavailable
Facility
$1209.51
No comparable office rate is available.
Connecticut
Connecticut · 35654
Office
Unavailable
Facility
$1311.90
No comparable office rate is available.
Fort Lauderdale
Florida · 35654
Office
Unavailable
Facility
$1414.58
No comparable office rate is available.
Rest Of Florida
Florida · 35654
Office
Unavailable
Facility
$1338.87
No comparable office rate is available.
Atlanta
Georgia · 35654
Office
Unavailable
Facility
$1285.45
No comparable office rate is available.
Rest Of Georgia
Georgia · 35654
Office
Unavailable
Facility
$1260.71
No comparable office rate is available.
Hawaii, Guam
Hawaii · 35654
Office
Unavailable
Facility
$1167.15
No comparable office rate is available.
Iowa
Iowa · 35654
Office
Unavailable
Facility
$1091.33
No comparable office rate is available.
Idaho
Idaho · 35654
Office
Unavailable
Facility
$1108.69
No comparable office rate is available.
East St. Louis
Illinois · 35654
Office
Unavailable
Facility
$1444.28
No comparable office rate is available.
Rest Of Illinois
Illinois · 35654
Office
Unavailable
Facility
$1344.93
No comparable office rate is available.
Suburban Chicago
Illinois · 35654
Office
Unavailable
Facility
$1415.01
No comparable office rate is available.
Indiana
Indiana · 35654
Office
Unavailable
Facility
$1112.67
No comparable office rate is available.
Kansas
Kansas · 35654
Office
Unavailable
Facility
$1112.84
No comparable office rate is available.
Kentucky
Kentucky · 35654
Office
Unavailable
Facility
$1199.90
No comparable office rate is available.
New Orleans
Louisiana · 35654
Office
Unavailable
Facility
$1256.50
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 35654
Office
Unavailable
Facility
$1208.61
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 35654
Office
Unavailable
Facility
$1279.25
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 35654
Office
Unavailable
Facility
$1214.62
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 35654
Office
Unavailable
Facility
$1313.70
No comparable office rate is available.
Rest Of Maryland
Maryland · 35654
Office
Unavailable
Facility
$1229.16
No comparable office rate is available.
Rest Of Maine
Maine · 35654
Office
Unavailable
Facility
$1141.14
No comparable office rate is available.
Southern Maine
Maine · 35654
Office
Unavailable
Facility
$1154.68
No comparable office rate is available.
Detroit
Michigan · 35654
Office
Unavailable
Facility
$1380.19
No comparable office rate is available.
Rest Of Michigan
Michigan · 35654
Office
Unavailable
Facility
$1250.41
No comparable office rate is available.
Minnesota
Minnesota · 35654
Office
Unavailable
Facility
$1087.92
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 35654
Office
Unavailable
Facility
$1221.55
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 35654
Office
Unavailable
Facility
$1229.11
No comparable office rate is available.
Rest Of Missouri
Missouri · 35654
Office
Unavailable
Facility
$1208.35
No comparable office rate is available.
Mississippi
Mississippi · 35654
Office
Unavailable
Facility
$1157.01
No comparable office rate is available.
Montana**
Montana · 35654
Office
Unavailable
Facility
$1236.07
No comparable office rate is available.
North Carolina
North Carolina · 35654
Office
Unavailable
Facility
$1146.96
No comparable office rate is available.
North Dakota**
North Dakota · 35654
Office
Unavailable
Facility
$1107.14
No comparable office rate is available.
Nebraska
Nebraska · 35654
Office
Unavailable
Facility
$1088.50
No comparable office rate is available.
New Hampshire
New Hampshire · 35654
Office
Unavailable
Facility
$1215.96
No comparable office rate is available.
Northern Nj
New Jersey · 35654
Office
Unavailable
Facility
$1331.30
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 35654
Office
Unavailable
Facility
$1306.85
No comparable office rate is available.
New Mexico
New Mexico · 35654
Office
Unavailable
Facility
$1266.75
No comparable office rate is available.
Nevada**
Nevada · 35654
Office
Unavailable
Facility
$1200.30
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 35654
Office
Unavailable
Facility
$1508.71
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 35654
Office
Unavailable
Facility
$1336.23
No comparable office rate is available.
Queens
New York · 35654
Office
Unavailable
Facility
$1417.19
No comparable office rate is available.
Rest Of New York
New York · 35654
Office
Unavailable
Facility
$1163.67
No comparable office rate is available.
Ohio
Ohio · 35654
Office
Unavailable
Facility
$1224.06
No comparable office rate is available.
Oklahoma
Oklahoma · 35654
Office
Unavailable
Facility
$1170.50
No comparable office rate is available.
Portland
Oregon · 35654
Office
Unavailable
Facility
$1212.54
No comparable office rate is available.
Rest Of Oregon
Oregon · 35654
Office
Unavailable
Facility
$1171.17
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 35654
Office
Unavailable
Facility
$1300.62
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 35654
Office
Unavailable
Facility
$1211.16
No comparable office rate is available.
Puerto Rico
Puerto Rico · 35654
Office
Unavailable
Facility
$1235.03
No comparable office rate is available.
Rhode Island
Rhode Island · 35654
Office
Unavailable
Facility
$1234.62
No comparable office rate is available.
South Carolina
South Carolina · 35654
Office
Unavailable
Facility
$1191.45
No comparable office rate is available.
South Dakota**
South Dakota · 35654
Office
Unavailable
Facility
$1091.90
No comparable office rate is available.
Tennessee
Tennessee · 35654
Office
Unavailable
Facility
$1120.84
No comparable office rate is available.
Austin
Texas · 35654
Office
Unavailable
Facility
$1222.84
No comparable office rate is available.
Beaumont
Texas · 35654
Office
Unavailable
Facility
$1206.37
No comparable office rate is available.
Brazoria
Texas · 35654
Office
Unavailable
Facility
$1193.97
No comparable office rate is available.
Dallas
Texas · 35654
Office
Unavailable
Facility
$1212.63
No comparable office rate is available.
Fort Worth
Texas · 35654
Office
Unavailable
Facility
$1213.83
No comparable office rate is available.
Galveston
Texas · 35654
Office
Unavailable
Facility
$1204.75
No comparable office rate is available.
Houston
Texas · 35654
Office
Unavailable
Facility
$1324.09
No comparable office rate is available.
Rest Of Texas
Texas · 35654
Office
Unavailable
Facility
$1207.06
No comparable office rate is available.
Utah
Utah · 35654
Office
Unavailable
Facility
$1204.51
No comparable office rate is available.
Virginia
Virginia · 35654
Office
Unavailable
Facility
$1169.70
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 35654
Office
Unavailable
Facility
$1235.03
No comparable office rate is available.
Vermont
Vermont · 35654
Office
Unavailable
Facility
$1127.29
No comparable office rate is available.
Rest Of Washington
Washington · 35654
Office
Unavailable
Facility
$1204.22
No comparable office rate is available.
Seattle (King Cnty)
Washington · 35654
Office
Unavailable
Facility
$1276.44
No comparable office rate is available.
Wisconsin
Wisconsin · 35654
Office
Unavailable
Facility
$1078.96
No comparable office rate is available.
West Virginia
West Virginia · 35654
Office
Unavailable
Facility
$1309.01
No comparable office rate is available.
Wyoming**
Wyoming · 35654
Office
Unavailable
Facility
$1179.88
No comparable office rate is available.
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 |
Where does this rate apply?
Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 35654 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1338.51
$1216.83 × 110% = $1338.51
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 35654 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
4,391
- Code
- 35654
- Physician work
- 25.62
- Practice expense
- 4.88
- Malpractice
- 6.52
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 25.62 | × 1.005 | 25.7481 |
| Practice expense | 4.88 | × 0.988 | 4.8214 |
| Malpractice | 6.52 | × 0.899 | 5.8615 |
| Total RVUs | 36.4310 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$1216.83
Open 35654 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 25.62 | 1.005 |
| Practice expense | 4.88 | 0.988 |
| Malpractice | 6.52 | 0.899 |
(25.62 × 1.005 + 4.88 × 0.988 + 6.52 × 0.899) × $33.4009 = $1216.83
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
35654 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1216.83 | RVU26D |
| 2026-07-01 | Not available in this setting | $1216.83 | RVU26C |
| 2026-04-01 | Not available in this setting | $1216.83 | RVU26B |
| 2026-01-01 | Not available in this setting | $1216.83 | RVU26A |
| 2025-10-01 | Not available in this setting | $1290.59 | RVU25D |
| 2025-07-01 | Not available in this setting | $1290.59 | RVU25C |
| 2025-04-01 | Not available in this setting | $1290.59 | RVU25B |
| 2025-01-01 | Not available in this setting | $1290.59 | RVU25A |
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
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503