Billing code 37605: Carotid ligationMedicare rate & RVUs in Texas
Surgical ligation of an internal or common carotid artery is reported when the surgeon ties off the vessel for a selected vascular or bleeding problem.
CMS doesn’t publish an office rate for 37605 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 37605 covers
The surgeon exposes and ties off an internal or common carotid artery, interrupting flow through the treated vessel. This uncommon open neck operation may be performed for selected carotid injury, uncontrolled bleeding, or an aneurysm when vessel ligation is the intended treatment. Vascular, trauma, or head-and-neck surgeons may perform it in an operating room, generally in a facility setting.
Report 37605 when the operative note supports ligation of the internal or common carotid artery; document the specific artery and the procedure performed. Distinguish the external carotid ligation code and the related carotid code whose descriptor specifies occlusion. The day-before preoperative visit and 90 days of related postoperative care are included in the 90-day global period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this descriptor and anatomy. 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 37605 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 | $668.05 |
| Beaumont | Unavailable | $658.69 |
| Brazoria | Unavailable | $652.10 |
| Dallas | Unavailable | $662.30 |
| Fort Worth | Unavailable | $662.93 |
| Galveston | Unavailable | $657.99 |
| Houston | Unavailable | $723.15 |
| Rest Of Texas | Unavailable | $659.16 |
How the 37605 rate is calculated
Each of 37605’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 · 37605
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 13.92Practice expense 2.74Malpractice 3.56
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 37605
37605 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 37605
Carotid ligation
| 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 · 37605
Carotid ligation
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
37605 without 51 · national facility
$675.37
Carotid ligation
37605-51 · Second procedure: 50%
$337.69
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%).
37605 compared with similar codes
Compare codes
37605 vs 37600 vs 37606 vs 35301: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 37600Carotid ligation
- This code concerns the internal or common carotid artery; 37600 is for the external carotid artery.
- 37606Carotid ligation
- Both concern internal or common carotid ligation, but 37606 specifies occlusion. The operative documentation must support the descriptor selected.
- 35301Arterial endarterectomy
- 35301 describes carotid endarterectomy, which removes obstructive material from the artery; 37605 is reported for tying off the artery.
37605 billing questions
How is 37605 distinguished from 37600?
37605 is for ligation of the internal or common carotid artery. Use 37600 when the external carotid artery is the vessel ligated.
When should 37606 be considered instead?
The 37606 descriptor specifies occlusion with internal or common carotid artery ligation. Select it only when the operative documentation supports that added descriptor detail.
Can modifier 50 be reported for both sides?
No. The descriptor and anatomy make modifier 50 inappropriate for bilateral adjustment.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
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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