Billing code 35523: Arterial bypassMedicare rate & RVUs in Texas
Reports a vein-graft bypass from the brachial artery to a radial or ulnar artery to restore blood flow through the forearm and hand.
CMS doesn’t publish an office rate for 35523 in Texas.
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 35523 covers
A vascular surgeon uses a vein graft to route blood from the brachial artery to the radial or ulnar artery. The operation may be performed for upper-extremity arterial occlusive disease causing inadequate forearm or hand perfusion. The operative report should identify the brachial inflow artery, the radial or ulnar outflow target, and the vein conduit used. The code describes the bypass reconstruction, not vein harvest by itself.
Select this code when the bypass begins at the brachial artery and ends at a radial or ulnar artery; the documented anastomosis sites distinguish it from other upper-extremity bypass codes. A separate vein harvest may be reported when performed and supported by the record. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care for 90 days. For multiple procedures in one 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 available; 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 35523 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $1,106.29 |
| Beaumont | Unavailable | $1,093.69 |
| Brazoria | Unavailable | $1,080.79 |
| Dallas | Unavailable | $1,097.92 |
| Fort Worth | Unavailable | $1,099.21 |
| Galveston | Unavailable | $1,090.70 |
| Houston | Unavailable | $1,200.89 |
| Rest Of Texas | Unavailable | $1,093.65 |
How the 35523 rate is calculated
Each of 35523’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 · 35523
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 23.53Practice expense 3.98Malpractice 6.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 35523
35523 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35523
Arterial 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 · 35523
Arterial 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
35523 without 50 · national facility
$1,119.93
Arterial bypass
35523-50 · Bilateral: 150%
$1,679.90
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).
35523 compared with similar codes
Compare codes
35523 vs 35522 vs 35525 vs 35500: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 35522Arterial bypass
- 35522 describes an axillary-to-brachial bypass. Choose 35523 when the bypass instead runs from the brachial artery to a radial or ulnar artery.
- 35525Arterial bypass
- 35525 is for a brachial-to-brachial bypass. For a brachial inflow with radial or ulnar outflow, use 35523.
- 35500Vein harvest
- 35500 describes vein harvest for bypass, rather than the arterial bypass reconstruction from the brachial artery to a forearm artery.
35523 billing questions
How do I distinguish this from a brachial-to-brachial bypass?
Use 35523 when the distal target is the radial or ulnar artery. A brachial artery target calls for the brachial-to-brachial code 35525.
Is vein harvest included in this bypass code?
The code describes the bypass using a vein conduit. A separately performed vein harvest may be reported with 35500 when supported by the operative documentation.
What operative details support selection of 35523?
Document the brachial inflow, whether the outflow target is radial or ulnar, and the vein graft used to create the bypass.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple-procedure reduction.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; 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 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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