No office rate
Both describe vein-graft carotid bypasses; 35501 applies to a bypass on the same side, while this code connects carotid arteries across the neck.
On this page
CMS RVU26D · Effective 2026-10-01
35509 Carotid bypass Medicare reimbursement rates in Maine
Reports a vein-graft bypass connecting carotid arteries on opposite sides of the neck to reroute blood flow around a diseased segment. Compare 35509 office and facility rates across CMS payment localities in Maine.
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 35509 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1185.24–$1196.98
2 of 2 localities have a supported rate.
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 35509: Contralateral carotid bypass with vein
Reports a vein-graft bypass connecting carotid arteries on opposite sides of the neck to reroute blood flow around a diseased segment.
This operation uses a vein conduit to connect one carotid artery to the carotid artery on the opposite side of the neck, creating a route for blood flow around a diseased or obstructed segment. A vascular surgeon typically performs the reconstruction in an operating room. The operative report should identify both carotid endpoints and the vein graft so the cross-neck bypass can be distinguished from a bypass on one side or a reconstruction involving another artery.
Select this code when the documented bypass connects contralateral carotid arteries using a vein graft. Documentation should support the conduit, the donor and recipient vessels, and the completed bypass. Medicare treats the service as major surgery with a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 for a bilateral procedure 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.
CMS billing rules for 35509
- 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 RVU27.39 · 71%
- Practice expense (office) RVU4.06 · 11%
- Malpractice RVU7.01 · 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.
35509 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
35506 uses a subclavian artery and a carotid artery as the bypass endpoints. This code connects carotid arteries on opposite sides.
No office rate
35508 connects a carotid artery to a vertebral artery. This code is selected when the bypass endpoints are contralateral carotid arteries.
Compare 35509 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$1185.24
Southern Maine →
Office / nonfacility
Unavailable
Facility
$1196.98
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35509 billing questions
How is this different from 35501?
This code describes a vein-graft bypass connecting carotid arteries on opposite sides of the neck. Code 35501 is for a carotid bypass on the same side.
When would 35506 be more appropriate?
Use 35506 when the bypass runs from a subclavian artery to a carotid artery. Choose this code when the documented endpoints are carotid arteries on opposite sides.
Does the 90-day global include related postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is a bilateral procedure handled?
For a bilateral procedure reported with modifier 50, CMS pays at 150% under the supplied fee schedule facts.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
What documentation supports choosing this code?
The operative report should identify the vein conduit and show that the bypass connects carotid arteries on opposite sides of the neck.
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.
4,33135501,,Art byp grft ipsilat carotid,A,,28.36,4.11,NA,4.11,,7.26,39.73,39.73,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,33235506,,Art byp grft subclav-carotid,A,,24.70,3.69,NA,3.69,,6.31,34.70,34.70,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,33335508,,Art byp grft carotid-vertbrl,A,,25.44,4.33,NA,4.33,,6.49,36.26,36.26,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,33435509,,Art byp grft contral carotid,A,,27.39,4.06,NA,4.06,,7.01,38.46,38.46,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,3353550F,,Low 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
4,33635510,,Art byp grft carotid-brchial,A,,23.78,3.63,NA,3.63,,6.08,33.49,33.49,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,33735511,,Art byp grft subclav-subclav,A,,21.65,3.35,NA,3.35,,5.53,30.53,30.53,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00