CPT code 35189: AV fistula repair, acquired, thorax or abdomen2026 Medicare rate & RVUs in California
Open vascular surgery to close an acquired artery-to-vein communication in the thorax or abdomen, reported when operative repair targets that site.
CMS doesn’t publish an office rate for 35189 in California.
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 35189 covers
This code describes operative repair of an acquired abnormal connection between an artery and a vein located in the thorax or abdomen. Such fistulas may follow trauma or a prior procedure. A vascular surgeon typically performs the repair in an operating room, using an approach suited to the affected vessels and the fistula’s location. The operative report should establish that the fistula is acquired and identify its thoracic or abdominal site.
Report the service for the repair itself, not for a congenital fistula or one in the head, neck, or extremity. The service has 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 multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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 35189 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $1,307.68 |
| Chico, CA | Unavailable | $1,287.53 |
| El Centro, CA | Unavailable | $1,288.78 |
| Fresno, CA | Unavailable | $1,287.53 |
| Hanford, CA | Unavailable | $1,287.53 |
| Los Angeles, CA | Unavailable | $1,355.64 |
| Madera, CA | Unavailable | $1,287.53 |
| Marin County, CA | Unavailable | $1,390.65 |
| Merced, CA | Unavailable | $1,287.53 |
| Modesto, CA | Unavailable | $1,287.53 |
| Napa, CA | Unavailable | $1,358.09 |
| Oxnard, CA | Unavailable | $1,332.59 |
| Redding, CA | Unavailable | $1,287.53 |
| Rest of California | Unavailable | $1,287.53 |
| Riverside, CA | Unavailable | $1,367.50 |
| Sacramento, CA | Unavailable | $1,315.93 |
| Salinas, CA | Unavailable | $1,310.46 |
| San Benito County, CA | Unavailable | $1,429.18 |
| San Diego, CA | Unavailable | $1,316.42 |
| San Francisco, CA | Unavailable | $1,382.17 |
| San Luis Obispo, CA | Unavailable | $1,293.85 |
| Santa Clara County, CA | Unavailable | $1,394.55 |
| Santa Cruz, CA | Unavailable | $1,308.93 |
| Santa Maria, CA | Unavailable | $1,308.56 |
| Santa Rosa, CA | Unavailable | $1,319.62 |
| Stockton, CA | Unavailable | $1,287.53 |
| Vallejo, CA | Unavailable | $1,345.88 |
| Visalia, CA | Unavailable | $1,287.53 |
| Yuba City, CA | Unavailable | $1,287.53 |
How the 35189 rate is calculated
Each of 35189’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 · 35189
RVUs × geographic indexes × conversion factor
Work29.23
29.23 RVUs× 1.000 GPCI
Practice expense4.40
4.40 RVUs× 1.000 GPCI
Malpractice7.46
7.46 RVUs× 1.000 GPCI
Adjusted RVUs
41.0900
Conversion factor
$33.4009
Medicare rate
$1,372.44
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 35189
35189 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35189
AV fistula repair, acquired, thorax or abdomen
| 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 · 35189
AV fistula repair, acquired, thorax or abdomen
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
35189 without 51 · national facility
$1,372.44
AV fistula repair, acquired, thorax or abdomen
35189-51 · Second procedure: 50%
$686.22
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%).
35189 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 35182AV fistula repairCongenital, thorax or abdomen
- Both codes cover thoracic or abdominal fistula repair; choose 35189 for an acquired fistula and 35182 when the fistula is congenital.
- 35188AV fistula repairAcquired, head and neck
- This code is for an acquired fistula in the head or neck. Use 35189 when the acquired fistula is in the thorax or abdomen.
- 35190AV fistula repairAcquired, extremity
- This code is for an acquired fistula in an extremity. Use 35189 for an acquired thoracic or abdominal fistula.
35189 billing questions
How do I distinguish this code from the congenital thoracoabdominal fistula repair code?
Use this code for an acquired fistula. The corresponding congenital code, 35182, is for a fistula documented as congenital.
Which anatomic sites qualify?
The fistula must be in the thorax or abdomen. Fistulas in the head or neck and in an extremity are represented by separate site-specific codes.
Can modifier 50 be used for bilateral repair?
No. CMS specifies that bilateral adjustment does not apply and modifier 50 is inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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
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