CPT 35211
Global 090 ActiveRpr blvsl dir ntrathrc w/byp
CPT 35211 Billing & Documentation Guide
CPT code 35211 (Rpr blvsl dir ntrathrc w/byp) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 23.97, a non-facility practice expense RVU of 9.63, and a malpractice RVU of 5.93, a total non-facility RVU of 39.53 and facility RVU of 39.53. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1322.2, though rates vary from $1169.77 to $1652.62 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 35211, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 35211 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 3 units of 35211 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 35211
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 23.97 | 23.97 |
| Practice Expense RVU | 9.63 | 9.63 |
| Malpractice RVU | 5.93 | 5.93 |
| Total RVU | 39.53 | 39.53 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 35211
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $1317.32 | $1317.32 | $1272.92 - $1458.67 | 29 |
| Florida | $1508.91 | $1508.91 | $1405.81 - $1636.37 | 3 |
| Georgia | $1345.67 | $1345.67 | $1323.63 - $1367.7 | 2 |
| Illinois | $1492.73 | $1492.73 | $1403.87 - $1584.05 | 4 |
| Michigan | $1381.43 | $1381.43 | $1317.9 - $1444.95 | 2 |
| North Carolina | $1227.28 | $1227.28 | $1227.28 - $1227.28 | 1 |
| New York | $1466.69 | $1466.69 | $1245.43 - $1602.11 | 5 |
| Ohio | $1293.94 | $1293.94 | $1293.94 - $1293.94 | 1 |
| Pennsylvania | $1334.62 | $1334.62 | $1283.07 - $1386.16 | 2 |
| Texas | $1305.67 | $1305.67 | $1277.33 - $1398.96 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 35211
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 35211 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0543T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0544T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0632T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 35211
What does CPT code 35211 mean? +
CPT code 35211 represents: Rpr blvsl dir ntrathrc w/byp. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 090.
What is the Medicare reimbursement for CPT 35211? +
The 2026 Medicare national average non-facility payment for CPT 35211 is $1322.2. Rates range from $1169.77 to $1652.62 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 35211? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 35211? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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