Billing code 35654: Arterial bypassMedicare rate & RVUs in Georgia
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.
CMS doesn’t publish an office rate for 35654 in Georgia.
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 9 sections
What 35654 covers
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.
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 35654 pays more and less in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta | Unavailable | $1,285.45 |
| Rest Of Georgia | Unavailable | $1,260.71 |
How the 35654 rate is calculated
Each of 35654’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 · 35654
RVUs × geographic indexes × conversion factor
Work25.62
25.62 RVUs× 1.000 GPCI
Practice expense4.88
4.88 RVUs× 1.000 GPCI
Malpractice6.52
6.52 RVUs× 1.000 GPCI
Adjusted RVUs
37.0200
Conversion factor
$33.4009
Medicare rate
$1,236.50
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 35654
35654 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35654
Arterial bypass
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 35654
Arterial bypass
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
35654 without 51 · national facility
$1,236.50
Arterial bypass
35654-51 · Second procedure: 50%
$618.25
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%).
35654 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 35661Femoral bypass
- Use 35661 for a femoral-to-femoral bypass with femoral inflow. This code describes axillary inflow supplying both femoral arteries.
- 35646Aortic bypass
- Use 35646 for an aortobifemoral bypass with aortic inflow. This code describes an extra-anatomic route from the axillary artery.
- 35623Arterial bypass
- Use 35623 when the axillary bypass outflow is to a popliteal or tibial artery, rather than to both femoral arteries.
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 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
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