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CPT code 35184: Fistula repair, congenital, extremity2026 Medicare rate & RVUs

Surgical repair of a congenital artery-to-vein connection in an arm or leg, reported when operative treatment addresses an extremity fistula.

CMS RVU26DEffective Oct 1, 2026109 payment localities15 Medicare services in 2024

Medicare pays $879.78 for 35184 nationally in a facility.

Medicare rate · 35184

Fistula repair, congenital, extremity

Office or facility?

Work RVUs
18.35
Total RVUs
26.34
Global days
090

National rate · 2026

$879.78

Facility setting, before claim adjustments.

See every locality for 35184 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 35184 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 35184 covers

This operation closes or reconstructs an abnormal artery-to-vein connection that has been present from birth in an arm or leg. A vascular surgeon typically performs it in an operating room, often for a congenital lesion causing high-flow shunting, limb enlargement, pain, or other effects of altered circulation. The operative report should establish the congenital fistula and identify the extremity treated; acquired fistulas and congenital fistulas in other body regions are coded differently.

Select this code based on both the congenital origin and extremity location, and document the operative work performed to repair the fistula. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral adjustment does not apply, so modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

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.

Where 35184 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

35184 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$798.02
AlaskaUnavailable$1,123.06
ArizonaUnavailable$853.81
ArkansasUnavailable$788.26
Atlanta, GAUnavailable$914.87
Austin, TXUnavailable$869.54
Bakersfield, CAUnavailable$840.76
Baltimore area, MDUnavailable$934.76
Beaumont, TXUnavailable$858.74
Brazoria, TXUnavailable$849.23

35184 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
35184 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 35184 rate is calculated

Each of 35184’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 35184

RVUs × geographic indexes × conversion factor

Office or facility?

Work18.35

18.35 RVUs× 1.000 GPCI

Practice expense3.30

3.30 RVUs× 1.000 GPCI

Malpractice4.69

4.69 RVUs× 1.000 GPCI

Adjusted RVUs

26.3400

Conversion factor

$33.4009

Medicare rate

$879.78

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 35184

35184 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 35184

Fistula repair, congenital, extremity

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.84/0.07Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 35184

Fistula repair, congenital, extremity

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

35184 without 51 · national facility

$879.78

Fistula repair, congenital, extremity

35184-51 · Second procedure: 50%

$439.89

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

35184 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 35184

    Fistula repair, congenital, extremity18.35 wRVU

    Not priced

  • 35190

    AV fistula repair, acquired, extremity13.08 wRVU

    Not priced

  • 35180

    AV fistula repair, congenital, head and neck14.72 wRVU

    Not priced

  • 35182

    AV fistula repair, congenital, thorax or abdomen30.92 wRVU

    Not priced

How to choose

35190AV fistula repairAcquired, extremity
Both address an extremity arteriovenous fistula; choose 35184 for a congenital fistula and 35190 for an acquired fistula.
35180AV fistula repairCongenital, head and neck
This is the congenital fistula repair code for the head and neck; 35184 is for an extremity.
35182AV fistula repairCongenital, thorax or abdomen
This is the congenital fistula repair code for the thorax or abdomen; 35184 is for an extremity.

Codes related to 35184

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 35184
CodeHow it relatesNational office range
Same family
35180AV fistula repair, congenital, head and neckCongenital fistula repair in the head and neck rather than an extremity.No office rate
35182AV fistula repair, congenital, thorax or abdomenCongenital fistula repair in the thorax or abdomen rather than an extremity.No office rate
Used instead
35190AV fistula repair, acquired, extremityRepair of an acquired arteriovenous fistula in an extremity.No office rate

35184 billing questions

How is this code distinguished from repair of an acquired fistula?

Use this code when the operative documentation identifies the extremity fistula as congenital. For an acquired extremity fistula, consider 35190.

Which congenital fistula repairs belong in this code?

The fistula must be in an extremity. Congenital repairs in the head or neck and in the thorax or abdomen have separate codes, 35180 and 35182.

Can modifier 50 be appended for repair of both extremities?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.

Is related postoperative care billed separately?

Related postoperative care during the 90-day global period is included, along with the preoperative visit on the day before surgery.

How are other procedures performed in the same session paid?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.

May an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 35184PPRRVU2026_Oct_nonQPP.csv, line 4,288 (RVU26D)

Open CMS sourceHow we calculate rates

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