CPT code 35184: Fistula repair, congenital, extremity2026 Medicare rate & RVUs in Texas
Surgical repair of a congenital artery-to-vein connection in an arm or leg, reported when operative treatment addresses an extremity fistula.
CMS doesn’t publish an office rate for 35184 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $869.54 |
| Beaumont, TX | Unavailable | $858.74 |
| Brazoria, TX | Unavailable | $849.23 |
| Dallas, TX | Unavailable | $862.61 |
| Fort Worth, TX | Unavailable | $863.54 |
| Galveston, TX | Unavailable | $856.97 |
| Houston, TX | Unavailable | $942.81 |
| Rest of Texas | Unavailable | $858.96 |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share 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.
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%).
35184 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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