No office rate
The route and single femoral target are the same, but 35621 is for a conduit other than vein; 35521 is for a vein conduit.
On this page
CMS RVU26D · Effective 2026-10-01
35521 Arterial bypass Medicare reimbursement rates in Indiana
Reports an open arterial bypass using vein from the axillary artery to one femoral artery to route blood around obstructed aortoiliac vessels. Compare 35521 office and facility rates across CMS payment localities in Indiana.
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 35521 in Indiana?
Indiana 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
$1005.95
1 of 1 localities have a supported rate.
Payment area: Indiana
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 35521: Axillary-to-femoral vein bypass
Reports an open arterial bypass using vein from the axillary artery to one femoral artery to route blood around obstructed aortoiliac vessels.
A vascular surgeon creates an extra-anatomic route from the axillary artery to a femoral artery using a vein conduit. This can restore lower-extremity blood flow when severe aortoiliac occlusive disease makes a direct aortic reconstruction unsuitable. The operation is performed in an operating room and includes the graft route and its arterial connections. The code identifies a single femoral outflow; a reconstruction branching to both femoral arteries is a different service.
Select the code when the operative report supports an axillary inflow, one femoral target, and a vein conduit. Document the bypass path, target artery, conduit, and laterality. The service has 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 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 is not permitted.
CMS billing rules for 35521
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU23.53 · 70%
- Practice expense (office) RVU3.95 · 12%
- Malpractice RVU6.02 · 18%
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.
35521 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
Use 35533 when the axillary-to-femoral vein bypass branches to both femoral arteries. 35521 describes a single femoral outflow.
No office rate
Both involve a vein bypass to a femoral artery, but 35539 uses aortic inflow; 35521 uses axillary inflow.
Compare 35521 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
Indiana →
Office / nonfacility
Unavailable
Facility
$1005.95
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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 35521 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
4,343
- Code
- 35521
- Physician work
- 23.53
- Practice expense
- 3.95
- Malpractice
- 6.02
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 23.53 | × 1.000 | 23.5300 |
| Practice expense | 3.95 | × 0.927 | 3.6617 |
| Malpractice | 6.02 | × 0.486 | 2.9257 |
| Total RVUs | 30.1174 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$1005.95
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 23.53 | 1 |
| Practice expense | 3.95 | 0.927 |
| Malpractice | 6.02 | 0.486 |
(23.53 × 1 + 3.95 × 0.927 + 6.02 × 0.486) × $33.4009 = $1005.95
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.
35521 billing questions
When should 35521 be selected instead of 35621?
Use 35521 for an axillary-to-femoral bypass using a vein conduit. Code 35621 is the corresponding axillary-to-femoral bypass using a conduit other than vein.
Does 35521 describe a bypass to both femoral arteries?
No. It describes one femoral outflow. A single axillary inflow graft that branches to both femoral arteries is represented by 35533 when performed with vein.
What operative details support reporting 35521?
Document the axillary inflow, the femoral target and laterality, the vein conduit, and the bypass route. The report should make clear whether the graft reaches one femoral artery or branches to both.
How does the 90-day global period affect follow-up billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. The bypass is major surgery under the CMS facts for this code.
How does Medicare treat bilateral reporting and surgical assistance?
A bilateral procedure reported with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeons require supporting documentation, and 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 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.
4,34035516,,Art byp grft subclav-axilary,A,,23.60,3.60,NA,3.60,,6.03,33.23,33.23,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,34135518,,Art byp grft axillary-axilry,A,,22.08,3.38,NA,3.38,,5.63,31.09,31.09,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,3423551F,,Intrmed rsk thromboembolism,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,34335521,,Art byp grft axill-femoral,A,,23.53,3.95,NA,3.95,,6.02,33.50,33.50,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,34435522,,Art byp grft axill-brachial,A,,22.57,3.54,NA,3.54,,5.76,31.87,31.87,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,34535523,,Art byp grft brchl-ulnr-rdl,A,,23.53,3.98,NA,3.98,,6.02,33.53,33.53,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,34635525,,Art byp grft brachial-brchl,A,,21.15,3.42,NA,3.42,,5.40,29.97,29.97,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915