Billing code 35642: Arterial bypassMedicare rate & RVUs in Washington
Reports open graft bypass from a carotid artery to a vertebral artery to route blood around disease affecting vertebral circulation.
CMS doesn’t publish an office rate for 35642 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 35642 covers
A vascular surgeon creates a graft route from a carotid artery to a vertebral artery, bypassing a diseased or obstructed segment. The operation is performed in the operating room and may be considered when vertebral circulation needs revascularization and the carotid artery is selected as the inflow vessel. The code is distinguished by these specific bypass endpoints, not simply by the diagnosis or intended improvement in blood flow.
Report the code when the operative documentation supports a graft bypass between the carotid and vertebral arteries. Confirm the documented inflow and outflow vessels, side, and graft construction; a bypass using the subclavian artery as the inflow is coded differently. CMS assigns 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 others at 50%. Bilateral reporting with modifier 50 is 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 35642 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $882.08 |
| Seattle (King Cnty) | Unavailable | $936.40 |
How the 35642 rate is calculated
Each of 35642’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 · 35642
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 18.47Practice expense 3.90Malpractice 4.72
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 35642
35642 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35642
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 · 35642
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
35642 without 50 · national facility
$904.83
Arterial bypass
35642-50 · Bilateral: 150%
$1,357.25
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).
35642 compared with similar codes
Compare codes
35642 vs 35645 vs 35606 vs 35626: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 35645Arterial bypass
- Both procedures use the vertebral artery as the bypass outflow. Report 35642 when the carotid artery supplies inflow and 35645 when the subclavian artery supplies inflow.
- 35606Arterial bypass
- This code describes a carotid-to-subclavian bypass. It does not describe a graft whose outflow is the vertebral artery.
- 35626Arterial bypass
- This code describes bypass from the aorta to a selected supra-aortic vessel; 35642 instead uses the carotid artery as inflow and the vertebral artery as outflow.
35642 billing questions
How does this differ from a subclavian-to-vertebral bypass?
Choose based on the documented inflow vessel. This code is for carotid-to-vertebral bypass; code 35645 describes subclavian-to-vertebral bypass.
Can modifier 50 be reported for bilateral bypasses?
When the procedure is performed bilaterally, CMS pays the service reported with modifier 50 at 150%.
What documentation supports reporting this code?
The operative report should identify the carotid inflow, vertebral outflow, side, and graft bypass performed.
Are postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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.
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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