Billing code 35647: Aortic bypassMedicare rate & RVUs in Texas
Open bypass from the aorta to one femoral artery using a vein conduit, typically to restore blood flow for aortoiliac occlusive disease.
CMS doesn’t publish an office rate for 35647 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 35647 covers
This service covers an open surgical bypass that carries blood from the aorta to a femoral artery through a vein graft. Vascular surgeons typically perform it in a hospital operating room for severe aortoiliac occlusive disease when improved blood flow to a leg is needed. The single femoral outflow distinguishes it from a bypass supplying both femoral arteries.
Report the code when the operative record supports the aorta-to-femoral route and use of a vein conduit. Document the indication, graft material, inflow and outflow vessels, and laterality. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures at 50%. If reported bilaterally with modifier 50, payment is at 150%. An assistant at surgery 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 35647 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 | $1,341.06 |
| Beaumont | Unavailable | $1,328.62 |
| Brazoria | Unavailable | $1,311.02 |
| Dallas | Unavailable | $1,332.03 |
| Fort Worth | Unavailable | $1,333.83 |
| Galveston | Unavailable | $1,323.20 |
| Houston | Unavailable | $1,459.01 |
| Rest Of Texas | Unavailable | $1,327.75 |
How the 35647 rate is calculated
Each of 35647’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 · 35647
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 28.99Practice expense 4.28Malpractice 7.42
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 35647
35647 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35647
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) | 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 · 35647
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 50 · payment effect
With and without the modifier
35647 without 50 · national facility
$1,359.08
Aortic bypass
35647-50 · Bilateral: 150%
$2,038.62
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).
35647 compared with similar codes
Compare codes
35647 vs 35646 vs 35637 vs 35638: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 35646Aortic bypass
- Choose 35647 for a vein bypass from the aorta to one femoral artery. Code 35646 is for an aortobifemoral bypass with bilateral femoral outflow.
- 35637Aortoiliac bypass
- Code 35637 ends at an iliac artery; this code ends at a femoral artery and uses a vein conduit.
- 35638Aortic bypass
- Code 35638 supplies both iliac arteries. This code supplies one femoral artery through a vein bypass.
35647 billing questions
How is this different from 35646?
This code is for an aorta-to-one-femoral-artery bypass using a vein conduit. Code 35646 describes an aortobifemoral bypass, with both femoral arteries as outflow targets.
What documentation supports this code?
The operative report should identify the aortic inflow, femoral outflow, vein conduit, laterality, and reason for bypass. These details distinguish it from bypasses to iliac or other arterial targets.
Is related postoperative care separately reported?
Related postoperative care during the 90-day global period is included, along with the day-before preoperative visit.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does Medicare handle another procedure performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%. When this code is reported bilaterally with modifier 50, payment is at 150%.
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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