Billing code 35540: Aortic bypassMedicare rate & RVUs in Guam
Reports open reconstruction carrying blood from the aorta to both femoral arteries when the surgeon uses an autogenous vein conduit.
CMS doesn’t publish an office rate for 35540 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 35540 covers
A vascular surgeon creates a route from the aorta to the right and left femoral arteries using the patient’s own vein as the graft. The operation is used to restore lower-extremity blood flow in selected patients with extensive aortoiliac occlusive disease. It is performed in an operating room, generally in a hospital facility; the specific vein source and graft configuration depend on the operative plan.
Report this code when the documented bypass has an aortic inflow, two femoral outflows, and an autogenous vein conduit. The operative report should identify the graft material and the bypass endpoints. The 90-day global period includes 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. The bifemoral targets are represented by this single code; modifier 50 is not added merely because the graft reaches both sides. Assistant-at-surgery payment is restricted, co-surgeons require 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.
35540 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $2,070.24 |
How the 35540 rate is calculated
Each of 35540’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 · 35540
RVUs × geographic indexes × conversion factor
Work48.10
48.10 RVUs× 1.000 GPCI
Practice expense5.93
5.93 RVUs× 1.000 GPCI
Malpractice12.33
12.33 RVUs× 1.000 GPCI
Adjusted RVUs
66.3600
Conversion factor
$33.4009
Medicare rate
$2,216.48
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 35540
35540 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35540
Aortic 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) | 1 | Not paid (statutory restriction). |
| 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 · 35540
Aortic 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
35540 without 50 · national facility
$2,216.48
Aortic bypass
35540-50 · Bilateral: 150%
$3,324.72
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).
35540 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 35646Aortic bypass
- Both codes describe an aorta-to-both-femoral bypass route. Choose based on conduit: 35540 is for vein, while 35646 is for a conduit other than vein.
- 35539Aortic bypass
- This code is for an aortic bypass to a femoral artery; 35540 describes outflow to both femoral arteries.
- 35538Aortic bypass
- This code routes the aortic bypass to both iliac arteries. 35540 has femoral rather than iliac outflows.
- 35521Arterial bypass
- This code uses an axillary inflow for a bypass to the femoral artery. 35540 uses the aorta as inflow and reaches both femoral arteries.
35540 billing questions
When is 35540 preferred over 35646?
Use 35540 when the aorta-to-both-femoral bypass uses the patient’s vein. Code 35646 describes the same general route when the conduit is other than vein.
Does the bifemoral graft require modifier 50?
No. The single code describes the aortic bypass to both femoral arteries, so the two outflow targets alone do not call for modifier 50.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
What should the operative report establish?
Document the aortic inflow, both femoral outflows, and use of the patient’s vein as the bypass conduit.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is subject to a statutory restriction. Co-surgeons are payable only with supporting documentation; team surgery is not permitted.
How are other procedures from the same session paid?
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
Fee sheets
Put 35540 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →