Billing code 35508: Arterial bypassMedicare rate & RVUs in Virginia
Reports a vein-graft bypass connecting a carotid artery to a vertebral artery when surgical revascularization is needed for compromised vertebral circulation.
CMS doesn’t publish an office rate for 35508 in Virginia.
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 35508 covers
The vascular surgeon creates a bypass from a carotid artery to a vertebral artery using a vein graft, routing blood around an obstructed or otherwise inadequate arterial segment. This reconstruction may be considered for selected patients with vertebrobasilar circulation problems when the carotid artery can provide inflow and the vertebral artery is an appropriate recipient. The procedure is generally performed in an operating room under surgical exposure of the vessels.
Select this code when the operative report identifies the carotid artery as the inflow vessel and the vertebral artery as the bypass destination. Documentation should establish the indication, the origin and endpoint of the graft, the conduit used, and the completed reconstruction. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 applies to bilateral performance, 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 35508 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $1,307.24 |
| Virginia | Unavailable | $1,144.93 |
How the 35508 rate is calculated
Each of 35508’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 · 35508
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 25.44Practice expense 4.33Malpractice 6.49
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 35508
35508 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35508
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 · 35508
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
35508 without 50 · national facility
$1,211.12
Arterial bypass
35508-50 · Bilateral: 150%
$1,816.68
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).
35508 compared with similar codes
Compare codes
35508 vs 35515 vs 35506 vs 35509: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 35515Arterial bypass
- Both codes involve a vertebral artery recipient. Choose 35508 for carotid inflow and 35515 for subclavian inflow.
- 35506Arterial bypass
- This code describes a subclavian-to-carotid bypass, not a carotid-to-vertebral reconstruction.
- 35509Carotid bypass
- This code describes a carotid bypass involving the contralateral carotid artery; 35508 requires a vertebral artery destination.
35508 billing questions
How is this code distinguished from a subclavian-to-vertebral bypass?
Use 35508 when the carotid artery supplies the bypass and the vertebral artery is the destination. A subclavian-to-vertebral reconstruction is reported with 35515.
What operative details support reporting 35508?
The operative report should identify the carotid inflow, vertebral recipient, vein conduit, indication, and completed bypass route.
Does the 90-day global period include routine postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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.
How does Medicare treat bilateral performance?
When the procedure is performed bilaterally and modifier 50 is used, CMS pays it 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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