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CMS RVU26D · Effective 2026-10-01

35638 Aortic bypass Medicare reimbursement rates in Arkansas

Reports open bypass from the aorta to both iliac arteries using a non-vein graft, typically to restore blood flow in aortoiliac disease. Compare 35638 office and facility rates across CMS payment localities in Arkansas.

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 35638 in Arkansas?

Arkansas has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.

Office / nonfacility

No supported rate

Facility setting

$1417.40

1 of 1 localities have a supported rate.

Payment area: Arkansas

One mapped payment locality.

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.

Find 35638 in your payment locality →

Vascular surgery

About 35638: Aortobi-iliac prosthetic bypass

Reports open bypass from the aorta to both iliac arteries using a non-vein graft, typically to restore blood flow in aortoiliac disease.

A vascular surgeon performs an open bypass from the aorta to both iliac arteries using a graft other than vein, commonly a synthetic conduit. The operation may be performed for aortoiliac occlusive disease when reconstruction is needed to restore blood flow to both lower extremities. The key distinction is that the graft runs from the aorta to bilateral iliac artery targets, rather than to the femoral arteries.

Select this code when the operative report supports the aortic origin, both iliac outflow targets, and use of a non-vein graft. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed 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 bilateral configuration. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

CMS billing rules for 35638

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 RVU32.76 · 69%
  • Practice expense (office) RVU6.30 · 13%
  • Malpractice RVU8.28 · 17%

127

Medicare services in 2024 · #4688 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.

35638 compared with similar codes

Office rates for Arkansas, from the same CMS release.

35637

Aortoiliac bypass

Aorta to one iliac artery

No office rate

This code identifies a bypass from the aorta to both iliac arteries. Distinguish the aortoiliac code by the documented target configuration rather than assuming bilateral iliac targets.

35646

Aortic bypass

To both femoral arteries

No office rate

Both codes describe aortic bypasses, but this code has iliac artery targets; 35646 has bilateral femoral artery targets.

35647

Aortic bypass

Single femoral target

No office rate

This code has bilateral iliac targets. 35647 is the aortofemoral alternative when the operative report identifies a femoral artery target.

Compare 35638 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.

1 of 1 payment localities

Office and facility base rates · shared scale starting at $0

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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 35638 in Arkansas.

PPRRVU2026_Oct_nonQPP.csv

4,385

Code
35638
Physician work
32.76
Practice expense
6.30
Malpractice
8.28

GPCI2026.csv

7

Locality
Arkansas
Physician work
1.000
Practice expense
0.859
Malpractice
0.515
Facility calculation for 35638 in Arkansas
ComponentRVULocality factorAdjusted
Physician work32.76× 1.00032.7600
Practice expense6.30× 0.8595.4117
Malpractice8.28× 0.5154.2642
Total RVUs42.4359
Conversion factor× 33.4009

Facility rate, Arkansas$1417.40

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.
Explore RVUs, geographic factors and the full formula

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work32.761
Practice expense6.30.859
Malpractice8.280.515

(32.76 × 1 + 6.3 × 0.859 + 8.28 × 0.515) × $33.4009 = $1417.40

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.

35638 billing questions

How does this differ from an aortobifemoral bypass?

This code describes aortic inflow with both iliac arteries as the distal targets. An aortobifemoral bypass has femoral artery targets instead.

When should the single aortoiliac bypass code be considered instead?

Use the bilateral-target code when the graft runs from the aorta to both iliac arteries. Aortoiliac bypass is the neighboring choice for a different, non-bilateral iliac configuration.

Should modifier 50 be appended for the two iliac targets?

No. CMS identifies bilateral adjustment as inappropriate for this code; the bilateral iliac configuration is represented by the service itself.

What operative documentation supports this code?

Document the aortic origin, both iliac artery targets, and that the conduit is not vein. The report should make clear that the distal targets are iliac arteries rather than femoral arteries.

How are other procedures in the same session handled?

CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full and other procedures are reduced when performed in the same session. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation.

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.

RVUs for 35638PPRRVU2026_Oct_nonQPP.csv, line 4,385 (RVU26D)
Geographic factors for ArkansasGPCI2026.csv, line 7 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet