No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
35642 Arterial bypass Medicare reimbursement rates in Wyoming
Reports open graft bypass from a carotid artery to a vertebral artery to route blood around disease affecting vertebral circulation. Compare 35642 office and facility rates across CMS payment localities in Wyoming.
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 35642 in Wyoming?
Wyoming has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$863.84
1 of 1 localities have a supported rate.
Payment area: Wyoming**
One mapped payment locality.
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 35642: Carotid-to-vertebral artery bypass
Reports open graft bypass from a carotid artery to a vertebral artery to route blood around disease affecting vertebral circulation.
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.
CMS billing rules for 35642
- 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU18.47 · 68%
- Practice expense (office) RVU3.90 · 14%
- Malpractice RVU4.72 · 17%
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.
35642 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
This code describes a carotid-to-subclavian bypass. It does not describe a graft whose outflow is the vertebral artery.
No office rate
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.
Compare 35642 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.
1 of 1 payment localities
Wyoming** →
Office / nonfacility
Unavailable
Facility
$863.84
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 35642 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
4,386
- Code
- 35642
- Physician work
- 18.47
- Practice expense
- 3.90
- Malpractice
- 4.72
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 18.47 | × 1.000 | 18.4700 |
| Practice expense | 3.90 | × 1.000 | 3.9000 |
| Malpractice | 4.72 | × 0.740 | 3.4928 |
| Total RVUs | 25.8628 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$863.84
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 18.47 | 1 |
| Practice expense | 3.9 | 1 |
| Malpractice | 4.72 | 0.74 |
(18.47 × 1 + 3.9 × 1 + 4.72 × 0.74) × $33.4009 = $863.84
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 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.
4,38335636,,Bpg splenorenal,A,,30.96,4.53,NA,4.53,,7.92,43.41,43.41,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,38435637,,Bpg aortoiliac,A,,32.22,4.67,NA,4.67,,8.25,45.14,45.14,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,38535638,,Bpg aortobi-iliac,A,,32.76,6.30,NA,6.30,,8.28,47.34,47.34,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,38635642,,Bpg carotid-vertebral,A,,18.47,3.90,NA,3.90,,4.72,27.09,27.09,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,38735645,,Bpg subclavian-vertebral,A,,17.97,3.31,NA,3.31,,4.60,25.88,25.88,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,38835646,,Bpg aortobifemoral,A,,32.16,5.87,NA,5.87,,8.17,46.20,46.20,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,38935647,,Bpg aortofemoral,A,,28.99,4.28,NA,4.28,,7.42,40.69,40.69,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,