Billing code 35331: Arterial endarterectomyMedicare rate & RVUs in Missouri
Open aortoiliac endarterectomy removes obstructive plaque from the aorta and iliac artery to restore blood flow in symptomatic occlusive disease.
CMS doesn’t publish an office rate for 35331 in Missouri.
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 35331 covers
A vascular surgeon performs this open operation to remove atherosclerotic material obstructing the aortoiliac arterial pathway. It is used for selected patients with aortoiliac occlusive disease causing symptoms such as limiting claudication or limb-threatening ischemia. The surgeon may use a patch to widen the treated vessel; that possibility is included in the procedure. The service is generally performed in a hospital operating room, rather than an office setting.
Report the code when the operative work is an endarterectomy involving the aortoiliac segment. The operative note should identify the treated artery or arteries, laterality, extent of plaque removal, and any patch repair. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during the 90 days after surgery. 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. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery services 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 35331 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City | Unavailable | $1,257.21 |
| Metropolitan St. Louis | Unavailable | $1,264.76 |
| Rest Of Missouri | Unavailable | $1,245.92 |
How the 35331 rate is calculated
Each of 35331’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 · 35331
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 27.03Practice expense 4.12Malpractice 6.90
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 35331
35331 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35331
Arterial endarterectomy
| 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 · 35331
Arterial endarterectomy
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
35331 without 50 · national facility
$1,270.90
Arterial endarterectomy
35331-50 · Bilateral: 150%
$1,906.35
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).
35331 compared with similar codes
Compare codes
35331 vs 35321 vs 35341 vs 35646: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 35321Arterial endarterectomy
- 35321 is for endarterectomy limited to the aorta. Report 35331 when the operative treatment involves the aortoiliac segment.
- 35341Arterial endarterectomy
- 35341 represents endarterectomy in a different arterial territory. Base code selection on the vessels actually treated, as documented in the operative report.
- 35646Aortic bypass
- 35646 describes an aortobifemoral bypass, not aortoiliac plaque removal. Choose according to whether the surgeon performed bypass or endarterectomy.
35331 billing questions
How is this code distinguished from an aorta-only endarterectomy?
Use this code when the documented endarterectomy involves the aortoiliac segment. An operation confined to the aorta is represented by the aorta-specific code, 35321.
Does the code include a patch graft?
Yes. The procedure may include patch angioplasty when performed as part of the endarterectomy; document the repair in the operative report.
Can an assistant surgeon be reported?
CMS permits payment for an assistant at surgery. Co-surgeon payment requires supporting documentation.
How is bilateral treatment reported?
When the service is performed bilaterally and reported with modifier 50, CMS pays at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days after 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 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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