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See a sample rate comparisonCPT 35216 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Rep Vessel Intrathor Wo Bypass
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Cardiovascular System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service 78 - Return to OR - related procedure |
| Complexity Level | High |
| Medicare Fee Schedule | $1,907.53 national non-facility rate (2026) · View Medicare rates for 35216 |
| Medicaid Fee Schedule | $1,491.89 median of the 8 states in the free preview · View Medicaid rates for 35216 |
National average reimbursement for CPT 35216 by major payers:
$2,587.05
$2,721.16
$3,015.27
$3,235.05
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CPT 35216
5 of 25 sample ratesHigher to lower in this preview
Ambulatory Surgery Center At Virtua Washington Township, L.L.C., Virtua Center For Surgery
Ambulatory Surgery Center At Virtua Washington Township, LLC
$4,300.00Published rateWakemed Surgery Center
$1,534.00Published rateThe Outpatient Center, LLC, The Outpatient Center Of Boynton Beach, Ltd.
The Outpatient Center Of Boynton Beach, Ltd.
$1,049.00Published rateOhio Eye Associates, Inc., Ohio Eye Associates Eye Surgery & Laser Center
Ohio Eye Associates, Inc.
$550.00Published rateIsland Eye Surgicenter LLC
$160.00Published rate
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See a sample payer proposalCPT 35216 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 35216 code is part of the Surgery services used for Surgical Procedures on the Cardiovascular System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 35216 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 35216. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 35216 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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