No office rate
Use 35646 when the aortic bypass reaches both femoral arteries. Use 35647 when it reaches one femoral artery.
On this page
CMS RVU26D · Effective 2026-10-01
35646 Aortic bypass Medicare reimbursement rates in Idaho
Reports a non-vein bypass from the aorta to both femoral arteries, commonly performed to restore lower-extremity blood flow in aortoiliac occlusive disease. Compare 35646 office and facility rates across CMS payment localities in Idaho.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 35646 in Idaho?
Idaho has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1383.63
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Vascular surgery
About 35646: Aortobifemoral arterial bypass
Reports a non-vein bypass from the aorta to both femoral arteries, commonly performed to restore lower-extremity blood flow in aortoiliac occlusive disease.
A vascular surgeon uses a conduit other than vein, typically a synthetic graft, to route blood from the aorta to the femoral artery in each groin. This operation is commonly performed in an operating room for extensive aortoiliac occlusive disease causing significant lower-extremity ischemia. The graft’s two limbs provide anatomic outflow to both sides; the operative report should identify the aortic inflow, both femoral targets, and conduit material.
Report this code when the bypass runs from the aorta to both femoral arteries using a non-vein conduit. Documentation should establish the indication, graft route and material, and the two distal anastomoses. 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. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 35646
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU32.16 · 70%
- Practice expense (office) RVU5.87 · 13%
- Malpractice RVU8.17 · 18%
872
Medicare services in 2024 · #3065 by national volume
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.
35646 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
Both describe an aortic-to-femoral bypass, but 35521 is the vein-conduit alternative; 35646 uses a conduit other than vein and reaches both femoral arteries.
No office rate
35638 routes the aortic bypass to both iliac arteries. 35646 routes it to both femoral arteries.
No office rate
35654 uses axillary inflow with a femoral-femoral configuration. 35646 uses aortic inflow and reaches both femoral arteries.
Compare 35646 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Idaho →
Office / nonfacility
Unavailable
Facility
$1383.63
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 35646 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
4,388
- Code
- 35646
- Physician work
- 32.16
- Practice expense
- 5.87
- Malpractice
- 8.17
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 32.16 | × 1.000 | 32.1600 |
| Practice expense | 5.87 | × 0.920 | 5.4004 |
| Malpractice | 8.17 | × 0.473 | 3.8644 |
| Total RVUs | 41.4248 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$1383.63
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 32.16 | 1 |
| Practice expense | 5.87 | 0.92 |
| Malpractice | 8.17 | 0.473 |
(32.16 × 1 + 5.87 × 0.92 + 8.17 × 0.473) × $33.4009 = $1383.63
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
35646 billing questions
How does 35646 differ from 35647?
35646 describes an aortic bypass to both femoral arteries. 35647 is the related aortofemoral code for a bypass to one femoral artery.
Does the conduit material affect code selection?
Yes. 35646 is for a conduit other than vein, typically a synthetic graft. For an aortofemoral bypass using vein, compare 35521.
Is a separate bypass code reported for each graft limb?
No. The two femoral destinations are part of the aortobifemoral bypass represented by 35646; document both distal targets in the operative report.
What documentation supports reporting 35646?
The operative report should show aortic inflow, bypass to both femoral arteries, the graft route, and use of a non-vein conduit.
How does the multiple-procedure payment rule affect another same-session procedure?
When another procedure is performed in the same session, CMS pays the highest-valued procedure in full and applies the standard 50% reduction to the others.
What are the assistant and co-surgeon payment rules?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; CMS does not permit team 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,38535638,,Bpg aortobi-iliac,A,,32.76,6.30,NA,6.30,,8.28,47.34,47.34,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,38635642,,Bpg carotid-vertebral,A,,18.47,3.90,NA,3.90,,4.72,27.09,27.09,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,38735645,,Bpg subclavian-vertebral,A,,17.97,3.31,NA,3.31,,4.60,25.88,25.88,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,38835646,,Bpg aortobifemoral,A,,32.16,5.87,NA,5.87,,8.17,46.20,46.20,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,38935647,,Bpg aortofemoral,A,,28.99,4.28,NA,4.28,,7.42,40.69,40.69,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,39035650,,Bpg axillary-axillary,A,,19.66,3.20,NA,3.20,,5.02,27.88,27.88,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,39135654,,Bpg axillary-femoral-femoral,A,,25.62,4.88,NA,4.88,,6.52,37.02,37.02,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772