No office rate
35691 directly transposes the vertebral artery to the carotid artery. 35642 describes a carotid-vertebral bypass rather than direct relocation.
On this page
CMS RVU26D · Effective 2026-10-01
35691 Arterial transposition Medicare reimbursement rates in Connecticut
Reports surgical relocation of a vertebral artery to the carotid artery to restore blood flow in selected patients with vertebral artery disease. Compare 35691 office and facility rates across CMS payment localities in Connecticut.
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 35691 in Connecticut?
Connecticut 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
$915.71
1 of 1 localities have a supported rate.
Payment area: Connecticut
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.
Vascular surgery
About 35691: Vertebral-to-carotid artery transposition
Reports surgical relocation of a vertebral artery to the carotid artery to restore blood flow in selected patients with vertebral artery disease.
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.
CMS billing rules for 35691
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU17.95 · 69%
- Practice expense (office) RVU3.31 · 13%
- Malpractice RVU4.58 · 18%
48
Medicare services in 2024 · #5376 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.
35691 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
35691 connects the vertebral artery directly to the carotid artery; 35645 describes a bypass from the subclavian artery to the vertebral artery.
No office rate
35691 transposes the vertebral artery to the carotid artery. 35694 concerns transposition of the subclavian artery to the carotid artery.
No office rate
35691 is a vertebral-to-carotid transposition; 35695 transposes the carotid artery to the subclavian artery.
Compare 35691 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
Connecticut →
Office / nonfacility
Unavailable
Facility
$915.71
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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 35691 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
4,403
- Code
- 35691
- Physician work
- 17.95
- Practice expense
- 3.31
- Malpractice
- 4.58
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.95 | × 1.020 | 18.3090 |
| Practice expense | 3.31 | × 1.077 | 3.5649 |
| Malpractice | 4.58 | × 1.210 | 5.5418 |
| Total RVUs | 27.4157 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$915.71
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.95 | 1.02 |
| Practice expense | 3.31 | 1.077 |
| Malpractice | 4.58 | 1.21 |
(17.95 × 1.02 + 3.31 × 1.077 + 4.58 × 1.21) × $33.4009 = $915.71
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.
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 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.
4,40035683,,Composite byp grft 3/> segmt,A,,8.28,0.66,NA,0.66,,2.11,11.05,11.05,0,ZZZ,0.00,0.00,0.00,0,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,40135685,,Bypass graft patency/patch,A,,3.94,0.39,NA,0.39,,1.02,5.35,5.35,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,40235686,,Bypass graft/av fist patency,A,,3.26,0.26,NA,0.26,,0.83,4.35,4.35,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,40335691,,Art trnsposj vertbrl carotid,A,,17.95,3.31,NA,3.31,,4.58,25.84,25.84,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,40435693,,Art trnsposj subclavian,A,,15.34,3.73,NA,3.73,,3.91,22.98,22.98,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,40535694,,Art trnsposj subclav carotid,A,,18.80,3.38,NA,3.38,,4.80,26.98,26.98,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,40635695,,Art trnsposj carotid subclav,A,,19.56,3.44,NA,3.44,,4.98,27.98,27.98,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
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