Billing code 34520: Venous bypassMedicare rate & RVUs in Guam
Reports a surgically created crossover vein graft that reroutes lower-extremity venous blood flow around an obstruction into the opposite-side venous system.
CMS doesn’t publish an office rate for 34520 in Guam.
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 34520 covers
A vascular surgeon creates a vein-graft pathway across the midline to reroute blood from an obstructed lower-extremity venous outflow into the opposite-side venous system. A typical clinical setting is chronic unilateral iliac venous obstruction when a crossover bypass, such as a Palma-Dale-type operation, is selected. The operative record should identify the obstruction, the veins used for inflow and outflow, the graft route, and the anastomoses.
Report this code for the crossover venous graft procedure, not simply for vein harvest or a valve repair. 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 other procedures are subject to the standard 50% reduction. A bilateral procedure reported with modifier 50 is paid at 150%. Assistant-at-surgery services may be paid; co-surgeons are paid only with supporting documentation. 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.
34520 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $852.42 |
How the 34520 rate is calculated
Each of 34520’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 · 34520
RVUs × geographic indexes × conversion factor
Work18.70
18.70 RVUs× 1.000 GPCI
Practice expense3.57
3.57 RVUs× 1.000 GPCI
Malpractice4.77
4.77 RVUs× 1.000 GPCI
Adjusted RVUs
27.0400
Conversion factor
$33.4009
Medicare rate
$903.16
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 34520
34520 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 34520
Venous 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 34520
Venous 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 50 · payment effect
With and without the modifier
34520 without 50 · national facility
$903.16
Venous bypass
34520-50 · Bilateral: 150%
$1,354.74
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
34520 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 34501Venous valve repair
- Choose 34501 for repair of a femoral vein valve. Choose 34520 when the operation creates a crossover vein graft to reroute lower-extremity venous flow.
- 34510Vein valve transposition
- Code 34510 describes transposition of a vein valve; 34520 describes a crossover graft bypassing an obstruction.
- 34502Cava reconstruction
- Code 34502 concerns vena cava reconstruction. Code 34520 is for a crossover graft connecting lower-extremity venous outflow across the midline.
34520 billing questions
When is this code appropriate instead of a venous valve procedure?
Use it for a crossover vein graft that reroutes lower-extremity venous flow. Codes 34501 and 34510 describe procedures directed at a femoral vein valve.
Does a crossover graft automatically require modifier 50?
No. The graft crosses between sides as part of the procedure; that fact alone does not make the service bilateral. CMS pays a bilateral procedure reported with modifier 50 at 150%.
What operative details support reporting this code?
Document the venous obstruction, the inflow and outflow vessels, the graft route across the midline, and the anastomoses. The record should establish that a crossover graft was created.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. The period applies to care related to this major surgery.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeons are paid only when supporting documentation is submitted; 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
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