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See a sample rate comparisonCPT 35538 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.
Aortobi Iliac
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Cardiovascular System |
| Common Place of Service | 21 - Inpatient Hospital |
| Common Modifiers | 22 - Increased Procedural Services 80 - Assistant surgeon 58 - Staged or related procedure during postoperative period |
| Complexity Level | High |
| Medicare Fee Schedule | $2,118.29 national non-facility rate (2026) · View Medicare rates for 35538 |
| Medicaid Fee Schedule | $1,634.235 median of the 8 states in the free preview · View Medicaid rates for 35538 |
National average reimbursement for CPT 35538 by major payers:
$2,931.58
$3,293.29
$3,386.02
$3,837.67
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CPT 35538
5 of 25 sample ratesHigher to lower in this preview
Monterey Peninsula Surgery Center LLC
Monterey Peninsula Surgery Center, LLC
$6,158.00Published rateOrthopedic Associates Surgery Center LLC
$1,147.00Published rateRockwood Clinic Ps, Rockwood Eye Surgery Center
Multicare Health System
$913.00Published rateOlol Pontchartrain Surgery Center, LLC, Our Lady Of The Lake Pontchartrain Surgery Center
Olol Pontchartrain Surgery Cente
$601.00Published rateAssociated Eye Surgical Center LLC
$312.00Published rate
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See a sample payer proposalCPT 35538 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 35538 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 35538 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.
| Code | Complexity | Description |
|---|---|---|
| 35361-CPT | High | Surgery For Blocked Artery, Surgery To Remove Plaque Or Clots From One Or More Arteries. The Procedure May Include Repairing A Damaged Blood Vessel With A Patch (Graft) From Another Blood Vessel. |
| 35363-CPT | High | Surgery For Blocked Artery, Surgery To Remove Plaque Or Clots From One Or More Arteries. The Procedure May Include Repairing A Damaged Blood Vessel With A Patch (Graft) From Another Blood Vessel. |
| 35537-CPT | High | Aortoiliac |
| 35538-CPT | High | Aortobi Iliac |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 35538. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 35538 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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