Billing code 35518: Arterial bypassMedicare rate & RVUs in Washington
Reports open graft bypass from one axillary artery to the other, commonly routing blood around an obstructed subclavian artery.
CMS doesn’t publish an office rate for 35518 in Washington.
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 35518 covers
A vascular surgeon creates an extra-anatomic route between the axillary arteries, typically across the chest, to improve blood flow when the usual arterial pathway is obstructed. This operation is commonly considered for symptomatic subclavian artery occlusive disease when the axillary arteries provide suitable inflow and outflow. The graft may be prosthetic or another documented conduit; the operative report should identify its route and both anastomotic vessels.
Choose this code when the bypass runs from axillary artery to axillary artery, rather than from a subclavian artery or to an arm or leg artery. The 90-day global period includes the day-before preoperative visit and related postoperative care through day 90. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 pricing is 150% for a bilateral procedure. 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 35518 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,009.06 |
| Seattle (King Cnty) | Unavailable | $1,066.52 |
How the 35518 rate is calculated
Each of 35518’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 · 35518
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 22.08Practice expense 3.38Malpractice 5.63
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 35518
35518 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35518
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 · 35518
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
35518 without 50 · national facility
$1,038.43
Arterial bypass
35518-50 · Bilateral: 150%
$1,557.65
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).
35518 compared with similar codes
Compare codes
35518 vs 35516 vs 35511 vs 35521 vs 35522: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 35516Arterial bypass
- Choose 35518 when the graft connects the two axillary arteries. Choose 35516 when the bypass runs from a subclavian artery to an axillary artery.
- 35511Artery bypass
- 35511 describes a subclavian-to-subclavian route. This code requires axillary arteries as both bypass endpoints.
- 35521Arterial bypass
- 35521 routes blood from an axillary artery to a femoral artery. This code connects one axillary artery to the other.
- 35522Arterial bypass
- 35522 ends at a brachial artery. Use this code when the bypass outflow is the opposite axillary artery.
35518 billing questions
How do I distinguish this from a subclavian-to-axillary bypass?
Use this code when both bypass endpoints are axillary arteries. A bypass beginning at a subclavian artery and ending at an axillary artery is a different configuration.
What operative documentation supports this code?
Document the bypass indication, the donor and recipient arteries, the graft route, and the conduit used. The record should make clear that the graft connects axillary artery to axillary artery.
Does the 90-day global include postoperative visits?
Yes. The day-before preoperative visit and related postoperative care through 90 days are included in the global period.
How is this code priced with other procedures in the same session?
The highest-valued procedure is paid in full, and other procedures are paid at 50%. For a bilateral procedure reported with modifier 50, the CMS pricing rule is 150%.
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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