Billing code 35650: Arterial bypassMedicare rate & RVUs in Illinois
Reports an extra-anatomic bypass connecting the right and left axillary arteries to reroute arterial blood around an obstructed inflow vessel.
CMS doesn’t publish an office rate for 35650 in Illinois.
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 35650 covers
An axillary-to-axillary bypass creates an extra-anatomic route between the right and left axillary arteries, typically using a prosthetic conduit tunneled beneath the skin across the chest. A vascular surgeon may perform it to reroute blood around an obstructed proximal inflow vessel, such as in subclavian artery disease, when circulation to an arm needs restoration. The operation is generally performed in a hospital operating room. The operative report should identify both arterial anastomoses, the conduit and tunnel, and the reason for the bypass.
Report 35650 when the bypass connects axillary artery to axillary artery using a conduit other than vein. Choose a neighboring bypass code by the documented inflow and outflow arteries, not simply the incision or disease location. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. When modifier 50 is appropriate for a bilateral service, CMS pays 150%; the two ends of this single crossover graft alone are not two separate bypasses. An assistant at surgery may be paid; co-surgeon payment requires 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.
Where 35650 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $1,153.48 |
| East St. Louis | Unavailable | $1,092.69 |
| Rest Of Illinois | Unavailable | $1,016.32 |
| Suburban Chicago | Unavailable | $1,068.14 |
How the 35650 rate is calculated
Each of 35650’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 · 35650
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 19.66Practice expense 3.20Malpractice 5.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 35650
35650 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35650
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 · 35650
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
35650 without 50 · national facility
$931.22
Arterial bypass
35650-50 · Bilateral: 150%
$1,396.83
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).
35650 compared with similar codes
Compare codes
35650 vs 35621 vs 35654 vs 35626: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 35621Arterial bypass
- Select 35621 when the bypass runs from the axillary artery to the femoral artery; 35650 connects the two axillary arteries.
- 35654Arterial bypass
- 35654 describes an axillary-to-femoral-to-femoral configuration. 35650 describes a crossover between the right and left axillary arteries.
- 35626Arterial bypass
- 35626 uses the aorta as inflow and routes blood to a subclavian, innominate, or carotid artery; 35650 uses axillary-to-axillary endpoints.
35650 billing questions
When should 35650 be selected instead of 35621?
Use 35650 when the documented bypass runs from axillary artery to axillary artery. Code 35621 describes a bypass from the axillary artery to the femoral artery.
Does the two-sided crossover graft require modifier 50?
The two axillary anastomoses are the endpoints of one crossover bypass, not two separate bypasses. If modifier 50 is appropriate for a separately reportable bilateral service, CMS pays 150%.
What operative documentation supports 35650?
Document the right and left axillary artery endpoints, the bypass conduit and route, and the clinical reason for rerouting blood flow. The report should make clear that the conduit is other than vein.
How does the 90-day global affect postoperative reporting?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those related services are part of the surgical global period.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; 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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