No office rate
Both codes describe an aorta-to-both-femoral bypass route. Choose based on conduit: 35540 is for vein, while 35646 is for a conduit other than vein.
On this page
CMS RVU26D · Effective 2026-10-01
35540 Aortic bypass Medicare reimbursement rates in Washington
Reports open reconstruction carrying blood from the aorta to both femoral arteries when the surgeon uses an autogenous vein conduit. Compare 35540 office and facility rates across CMS payment localities in Washington.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 35540 in Washington?
Washington has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$2149.44–$2266.41
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Vascular surgery
About 35540: Aortobifemoral bypass with vein
Reports open reconstruction carrying blood from the aorta to both femoral arteries when the surgeon uses an autogenous vein conduit.
A vascular surgeon creates a route from the aorta to the right and left femoral arteries using the patient’s own vein as the graft. The operation is used to restore lower-extremity blood flow in selected patients with extensive aortoiliac occlusive disease. It is performed in an operating room, generally in a hospital facility; the specific vein source and graft configuration depend on the operative plan.
Report this code when the documented bypass has an aortic inflow, two femoral outflows, and an autogenous vein conduit. The operative report should identify the graft material and the bypass endpoints. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. The bifemoral targets are represented by this single code; modifier 50 is not added merely because the graft reaches both sides. Assistant-at-surgery payment is restricted, co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 35540
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU48.10 · 72%
- Practice expense (office) RVU5.93 · 9%
- Malpractice RVU12.33 · 19%
12
Medicare services in 2024 · #6146 by national volume
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.
35540 compared with similar codes
Office rates for Washington, from the same CMS release.
No office rate
This code is for an aortic bypass to a femoral artery; 35540 describes outflow to both femoral arteries.
No office rate
This code routes the aortic bypass to both iliac arteries. 35540 has femoral rather than iliac outflows.
No office rate
This code uses an axillary inflow for a bypass to the femoral artery. 35540 uses the aorta as inflow and reaches both femoral arteries.
Compare 35540 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Rest Of Washington →
Office / nonfacility
Unavailable
Facility
$2149.44
Seattle (King Cnty) →
Office / nonfacility
Unavailable
Facility
$2266.41
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35540 billing questions
When is 35540 preferred over 35646?
Use 35540 when the aorta-to-both-femoral bypass uses the patient’s vein. Code 35646 describes the same general route when the conduit is other than vein.
Does the bifemoral graft require modifier 50?
No. The single code describes the aortic bypass to both femoral arteries, so the two outflow targets alone do not call for modifier 50.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
What should the operative report establish?
Document the aortic inflow, both femoral outflows, and use of the patient’s vein as the bypass conduit.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is subject to a statutory restriction. Co-surgeons are payable only with supporting documentation; team surgery is not permitted.
How are other procedures from the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,35335537,,Art byp grft aortoiliac,A,,40.83,5.35,NA,5.35,,10.46,56.64,56.64,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,35435538,,Art byp grft aortobi-iliac,A,,45.85,5.82,NA,5.82,,11.75,63.42,63.42,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,35535539,,Art byp grft aortofemoral,A,,43.01,5.52,NA,5.52,,11.01,59.54,59.54,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,35635540,,Art byp grft aortbifemoral,A,,48.10,5.93,NA,5.93,,12.33,66.36,66.36,0,090,0.09,0.84,0.07,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,35735556,,Art byp grft fem-popliteal,A,,26.08,5.08,NA,5.08,,6.62,37.78,37.78,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,35835558,,Art byp grft fem-femoral,A,,22.55,4.80,NA,4.80,,5.68,33.03,33.03,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,3593555F,,Pt inr measurement performed,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00