CPT CODESurgery (Digestive)Status A

CPT Code 47535Complete Billing & Coding Guide (2026)Conversion ext bil drg cath

Reviewed by AAPC-Certified Coders2026 Medicare Fee ScheduleCMS + AMA Sources
Medicare Payment
$848
Non-facility · National avg
Facility
$169
Total RVU
25.40
Global
000
Payment
$848
non-facility
Work RVU
3.85
physician effort
Global Period
000
post-op days
Bundling Edits
10
NCCI pairs

About CPT 47535

CPT 47535 is a Current Procedural Terminology code in the Surgery (Digestive) category maintained by the American Medical Association. The CMS short descriptor reads "Conversion ext bil drg cath". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.

Documentation specificity, correct ICD-10 linkage, and modifier accuracy determine whether 47535 pays cleanly or triggers a denial. Verify CMS National Physician Fee Schedule status, applicable Medicare LCDs, and any payer-specific medical policies before submission.

Pro Tip

47535 has 10 NCCI bundling edit pairs documented. Run your scrubber against the NCCI quarterly update before submission. When clinically warranted, use modifier 59 or the X-modifiers (XE, XS, XP, XU) to bypass an indicator-1 edit, with chart documentation supporting the distinct service.

Code Properties

Global Period
000
0-day global period (no postoperative days)
Status Indicator
A
Active. Payment under Medicare PFS.
Conversion Factor
$33.4009
CMS national rate
Effective Date
2026-04-01
per CMS publication

RVU Breakdown

Every CPT code’s Medicare payment is calculated from three Relative Value Unit components: physician work, practice expense, and malpractice. Together they multiply by the conversion factor to produce the payment amount.

RVU Composition
25.40 total RVU
3.85
21.12
Work RVU
3.85 · 15%
Physician time + skill
Practice Expense
21.12 · 83%
Office & equipment
Malpractice
0.43 · 2%
Liability insurance
Non-Facility
Private office · urgent care · ambulatory
Most billed
$848.38
25.40 RVU × $33.4009 CF
Facility
Hospital · ASC · nursing home
$169.34
5.07 RVU × $33.4009 CF

Payment = Total RVU × Conversion Factor ($33.4009) × Geographic Adjustment (GPCI). National averages shown. Actual payment varies by locality.

Medicare Payment by State

Medicare adjusts payment by locality based on GPCI (Geographic Practice Cost Index). Higher cost-of-living areas like California and New York pay more. Rural states pay less. Top 12 states shown.

DC
$983
CA
$976
AK
$952
WA
$948
NJ
$945
NY
$941
HI
$939
MA
$937
CT
$908
CO
$892
OR
$883
MD
$881

Showing top 12 of 53 states. Full locality data available in CMS PFS Locality file.

NCCI Bundling Edits

10 pairs

These codes trigger National Correct Coding Initiative edits when billed with 47535. An indicator of 0 means the pair cannot be unbundled. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with supporting documentation.

Common Denial Risk

Billing 47535 alongside a bundled code without the correct modifier generates CARC 97 denials. Payers often flag these as audit risks. Document medical necessity for the separate service and apply modifier 59 or the appropriate X-modifier (XE, XS, XP, XU) only when clinically justified.

AR Recovery Note

Multi-procedure NCCI edits hit surgical specialties harder than any other category. CO-97 denials on 47535 are frequently recoverable when the operative note documents distinct anatomic sites or staged steps. Our coders read the op note against the edit pair and pick the right modifier (XS preferred over modifier 59 for distinct structures).

Applicable Modifiers

Modifiers commonly paired with 47535 based on its category. Apply only when the clinical circumstance warrants. Incorrect modifier use is a top audit target.

22
Increased procedural services — work substantially greater than typically required
When to use · When the work required for a procedure is substantially more than usual (e.g., morbid obesity, extensive adhesions, unusual anatomy). Request additional payment.
33
Preventive services — when the primary purpose is delivery of an evidence-based service per USPSTF A or B recommendation
When to use · Screening services (colonoscopy, mammography, etc.) to indicate the primary purpose is preventive. Waives cost-sharing under ACA.
50
Bilateral procedure — performed on both sides of the body during the same operative session
When to use · When a procedure is performed on both sides (e.g., bilateral knee injections, bilateral cataract surgery). Payment = 150% of unilateral rate.
51
Multiple procedures — when multiple procedures (other than E/M) are performed at the same session
When to use · Second and subsequent procedures during the same session. Payment is typically reduced to 50% for the 2nd procedure, 25% for the 3rd+.
52
Reduced services — when a procedure is partially reduced or eliminated at the physician's discretion
When to use · When a procedure is not completed to its full extent (e.g., incomplete colonoscopy that didn't reach cecum). Payment reduced by payer discretion.
53
Discontinued procedure — physician elected to terminate/discontinue a procedure due to patient risk
When to use · When a surgical procedure is started but discontinued due to patient safety concerns (e.g., anesthesia complications, intraoperative findings).
54
Surgical care only
When to use · When the surgeon provided ONLY the surgery, not pre/post op care
55
Postoperative management only
When to use · When you managed post-op but another physician performed the surgery
AR Recovery Note

Modifier 24, 79, 78, and 58 on global-period claims are the highest-recovery surgical billing levers. 47535 carries a 000 global indicator. Our team flags every encounter inside an active global period for the right modifier decision.

Free 90-Day AR Recovery Audit

Find the revenue leakage in your 47535 claims.

Wrong modifier, missing documentation, bundling without justification, stale ICD-10 linkage: these are the silent revenue killers on Surgery (Digestive) claims. Our AAPC-certified team audits your last 90 days of 47535 claims, surfaces the recoverable dollars, and appeals them. Free, no obligation.

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FAQ

Everything about CPT 47535

What does CPT code 47535 cover?

CPT 47535 is a Current Procedural Terminology code in the Surgery (Digestive) category maintained by the American Medical Association. The CMS short descriptor reads "Conversion ext bil drg cath". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.

What is the Medicare payment for CPT 47535?

The national average Medicare payment for CPT 47535 is approximately $848.38 in a non-facility setting and $169.34 in a facility setting. Actual payment varies by locality based on GPCI adjustments. Total RVU is 25.4 with a conversion factor of $33.4009.

What is the global period for CPT 47535?

CPT 47535 has a 0-day global period (indicator 000). Same-day E/M is bundled into the procedure, but office visits the next day or after are separately billable for unrelated care. Use modifier 24 for unrelated E/M during the global period.

What codes bundle with CPT 47535?

CPT 47535 has NCCI Procedure-to-Procedure edits with 10+ codes including 0213T, 0216T, 0596T. Modifier indicator 0 means the edit cannot be bypassed. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with documentation.

CMS Medicare Physician Fee ScheduleNCCI Edits · Current QuarterAMA CPT Code Set

CPT codes and descriptions are copyright of the American Medical Association. RVU values reflect current CMS publications. Actual payment varies by locality. Commercial payer rates vary by contract.

Free 90-Day AR Recovery Audit

We audit your last 90 days of claims and surface the revenue leakage: wrong modifiers, missed bundling appeals, ICD-10 specificity gaps. AAPC-certified coders. 2.49% of collections. No setup fees.