Billing code 35509: Carotid bypassMedicare rate & RVUs in Oklahoma
Reports a vein-graft bypass connecting carotid arteries on opposite sides of the neck to reroute blood flow around a diseased segment.
CMS doesn’t publish an office rate for 35509 in Oklahoma.
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 35509 covers
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.
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 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | Unavailable | $1,217.88 |
How the 35509 rate is calculated
Each of 35509’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 · 35509
RVUs × geographic indexes × conversion factor
Work27.39
27.39 RVUs× 1.000 GPCI
Practice expense4.06
4.06 RVUs× 1.000 GPCI
Malpractice7.01
7.01 RVUs× 1.000 GPCI
Adjusted RVUs
38.4600
Conversion factor
$33.4009
Medicare rate
$1,284.60
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 35509
35509 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35509
Carotid 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 · 35509
Carotid 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
35509 without 50 · national facility
$1,284.60
Carotid bypass
35509-50 · Bilateral: 150%
$1,926.90
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).
35509 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 35501Carotid bypass
- Both describe vein-graft carotid bypasses; 35501 applies to a bypass on the same side, while this code connects carotid arteries across the neck.
- 35506Arterial bypass
- 35506 uses a subclavian artery and a carotid artery as the bypass endpoints. This code connects carotid arteries on opposite sides.
- 35508Arterial bypass
- 35508 connects a carotid artery to a vertebral artery. This code is selected when the bypass endpoints are contralateral carotid arteries.
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 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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