Billing code 35565: Arterial bypassMedicare rate & RVUs in Guam
Reports open revascularization using a vein graft from an iliac artery to a femoral artery to route blood around diseased arterial segments.
CMS doesn’t publish an office rate for 35565 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 35565 covers
A vascular surgeon uses a vein conduit to create a new path for blood between an iliac artery and a femoral artery, bypassing a diseased or blocked segment. The operation is typically performed in a hospital or other surgical facility for lower-extremity revascularization, often in patients with significant peripheral arterial disease. The code identifies the bypass by its arterial endpoints and vein conduit, not simply by the diagnosis or the location of the blockage.
The operative report should establish the iliac inflow, femoral outflow, use of a vein graft, and the side or sides treated. CMS classifies this as major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with 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.
35565 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $1,091.67 |
How the 35565 rate is calculated
Each of 35565’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 · 35565
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 24.50Practice expense 4.01Malpractice 6.26
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 35565
35565 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35565
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) | 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 · 35565
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 50 · payment effect
With and without the modifier
35565 without 50 · national facility
$1,161.35
Arterial bypass
35565-50 · Bilateral: 150%
$1,742.03
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).
35565 compared with similar codes
Compare codes
35565 vs 35563 vs 35665 vs 35539: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 35563Iliac bypass
- 35563 connects one iliac artery to another. Use 35565 when the documented bypass runs from an iliac artery to a femoral artery.
- 35665Arterial bypass
- The arterial endpoints are iliofemoral in both codes; choose based on the conduit, with 35565 for a vein graft and 35665 for a non-vein graft.
- 35539Aortic bypass
- 35539 describes a vein-graft bypass from the aorta to the femoral artery. 35565 has an iliac artery as the inflow source.
35565 billing questions
How is 35565 distinguished from 35665?
35565 describes an iliofemoral bypass using a vein conduit. 35665 is the corresponding iliofemoral bypass using a non-vein graft.
What operative details support reporting 35565?
Document the iliac artery used for inflow, the femoral artery used for outflow, and that a vein graft forms the bypass. Record the side or sides treated.
How should a bilateral iliofemoral bypass be reported?
CMS lists this as a bilateral procedure; report modifier 50 when the service is performed bilaterally. CMS payment is 150% for bilateral reporting with modifier 50.
Is related postoperative care separately reported during the global period?
The day-before preoperative visit and 90 days of related postoperative care are included in the 90-day global period.
How is 35565 affected when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
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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