Billing code 35538: Aortic bypassMedicare rate & RVUs in Massachusetts
Reports an aortobi-iliac arterial bypass using a vein conduit to route blood from the aorta to both iliac arteries.
CMS doesn’t publish an office rate for 35538 in Massachusetts.
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 35538 covers
A vascular surgeon performs this open bypass by connecting a vein conduit between the aorta and both iliac arteries, creating a route around diseased or obstructed aortoiliac segments. The operation is performed in a surgical setting and may be considered for aortoiliac occlusive disease when revascularization to both iliac targets is needed. The bilateral iliac destination distinguishes this reconstruction from bypasses ending at one iliac or at the femoral arteries.
Report the code for the aorta-to-both-iliac vein bypass actually performed; the operative report should identify the conduit and both distal target arteries. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and related postoperative care. For other procedures performed in the same session, the highest-valued procedure is paid in full and additional procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate because bilateral anatomy is inherent. Assistant-at-surgery payment may be made; 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 35538 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston | Unavailable | $2,175.62 |
| Rest Of Massachusetts | Unavailable | $2,073.42 |
How the 35538 rate is calculated
Each of 35538’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 · 35538
RVUs × geographic indexes × conversion factor
Work45.85
45.85 RVUs× 1.000 GPCI
Practice expense5.82
5.82 RVUs× 1.000 GPCI
Malpractice11.75
11.75 RVUs× 1.000 GPCI
Adjusted RVUs
63.4200
Conversion factor
$33.4009
Medicare rate
$2,118.29
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 35538
35538 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35538
Aortic 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 35538
Aortic 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 51 · payment effect
With and without the modifier
35538 without 51 · national facility
$2,118.29
Aortic bypass
35538-51 · Second procedure: 50%
$1,059.15
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
35538 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 35537Aortoiliac bypass
- Choose 35538 when the bypass reaches both iliac arteries; 35537 describes an aortoiliac vein bypass with a different target configuration.
- 35540Aortic bypass
- Choose 35540 for an aorta-to-both-femoral-arteries vein bypass. This code ends at both iliac arteries instead.
- 35631Aortic bypass
- The distal anatomy is the same, but 35631 is for an aortobi-iliac bypass using a conduit other than vein.
35538 billing questions
How is this different from an aortobifemoral bypass?
This reconstruction terminates at both iliac arteries. An aortobifemoral bypass has distal targets in both femoral arteries.
Does the code describe a vein conduit?
Yes. This code is in the vein-graft bypass series; the operative report should support the conduit used.
Should modifier 50 be appended?
No. The code describes the bypass to both iliac arteries, so the bilateral anatomy is built into the service.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% multiple-procedure reduction.
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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