Billing code 35645: Arterial bypassMedicare rate & RVUs in Guam
Open bypass using a non-vein conduit from the subclavian artery to the vertebral artery to restore blood flow in selected vascular disease.
CMS doesn’t publish an office rate for 35645 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 35645 covers
This open operation creates a route for blood from the subclavian artery into the vertebral artery using a conduit other than vein. Vascular surgeons may perform it when vertebral artery flow needs surgical restoration, including selected cases of impaired circulation to the posterior brain. The operation typically requires exposure in the neck and upper chest and is performed in an operating room.
Report this code when the documented donor and recipient vessels are the subclavian and vertebral arteries and the conduit is not vein. The operative report should establish the bypass anatomy, conduit, side, and clinical indication. The CMS 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment 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.
35645 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $814.88 |
How the 35645 rate is calculated
Each of 35645’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 · 35645
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 17.97Practice expense 3.31Malpractice 4.60
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 35645
35645 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35645
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 · 35645
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
35645 without 50 · national facility
$864.42
Arterial bypass
35645-50 · Bilateral: 150%
$1,296.63
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).
35645 compared with similar codes
Compare codes
35645 vs 35642 vs 35612: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 35642Arterial bypass
- Both bypass to the vertebral artery using a non-vein conduit. Choose by the documented donor artery: carotid for 35642, subclavian for 35645.
- 35612Arterial bypass
- Both involve a subclavian donor artery and a non-vein conduit, but 35612 ends at the opposite subclavian artery rather than the vertebral artery.
35645 billing questions
How does this differ from 35545?
Both codes describe a subclavian-to-vertebral bypass, but 35545 is for a vein conduit. Use 35645 when the conduit is other than vein.
When would 35642 be considered instead?
35642 describes a carotid-to-vertebral bypass. The donor artery documented in the operative report distinguishes it from this subclavian-origin bypass.
Are the anastomoses or surgical exposure separately represented?
The reported service is the completed bypass between the named arteries. Do not treat its component steps as separate bypasses.
How is bilateral reporting handled?
When the procedure is performed bilaterally, CMS lists modifier 50 payment at 150%. The record should support the work on both sides.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted under the listed CMS rules.
What postoperative care falls within the global period?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
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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