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CPT code 35226: Vessel repair, direct repair, lower extremity2026 Medicare rate & RVUs

Reports direct surgical repair of a blood vessel in the lower extremity, such as during treatment of a traumatic or operative vascular injury.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.1K Medicare services in 2024

Medicare pays $756.53 for 35226 nationally in a facility.

Medicare rate · 35226

Vessel repair, direct repair, lower extremity

Office or facility?

Work RVUs
14.92
Total RVUs
22.65
Global days
090

National rate · 2026

$756.53

Facility setting, before claim adjustments.

See every locality for 35226 →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 35226 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 35226 covers

This service covers direct surgical repair of a blood vessel in the lower extremity, such as repairing a vessel injured by trauma or during another operation. A vascular, trauma, or other surgeon performs the repair in an operative setting. The operative report should identify the vessel and site, describe the injury or defect, and explain the direct repair performed.

Select this code when the documented approach is direct repair rather than reconstruction using a vein graft or another graft. It has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Modifier 50 reports bilateral procedures and pays at 150%. 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 35226 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

35226 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$685.55
AlaskaUnavailable$958.10
ArizonaUnavailable$734.37
ArkansasUnavailable$677.04
Atlanta, GAUnavailable$785.33
Austin, TXUnavailable$750.96
Bakersfield, CAUnavailable$729.79
Baltimore area, MDUnavailable$803.89
Beaumont, TXUnavailable$735.67
Brazoria, TXUnavailable$731.76

35226 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
35226 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 35226 rate is calculated

Each of 35226’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 · 35226

RVUs × geographic indexes × conversion factor

Office or facility?

Work14.92

14.92 RVUs× 1.000 GPCI

Practice expense3.98

3.98 RVUs× 1.000 GPCI

Malpractice3.75

3.75 RVUs× 1.000 GPCI

Adjusted RVUs

22.6500

Conversion factor

$33.4009

Medicare rate

$756.53

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

Payment rules and modifiers for 35226

35226 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 35226

Vessel repair, direct repair, lower 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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
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 · 35226

Vessel repair, direct repair, lower 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 50 · payment effect

With and without the modifier

35226 without 50 · national facility

$756.53

Vessel repair, direct repair, lower extremity

35226-50 · Bilateral: 150%

$1,134.80

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

35226 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 35226

    Vessel repair, direct repair, lower extremity14.92 wRVU

    Not priced

  • 35206

    Vessel repair, upper extremity, direct repair13.49 wRVU

    Not priced

  • 35207

    Vessel repair, direct repair, hand or finger10.67 wRVU

    Not priced

  • 35256

    Vessel repair, lower extremity, vein graft18.58 wRVU

    Not priced

  • 35286

    Vessel repair, lower extremity, non-vein graft16.76 wRVU

    Not priced

How to choose

35206Vessel repairUpper extremity, direct repair
Use 35206 for direct repair of an upper-extremity vessel. Use 35226 when the repaired vessel is in the lower extremity.
35207Vessel repairDirect repair, hand or finger
35207 identifies direct repair of a vessel in the hand or finger. This code applies to direct repair in the lower extremity.
35256Vessel repairLower extremity, vein graft
Both concern lower-extremity vessel repair, but 35256 is for repair using a vein graft; this code is for direct repair.
35286Vessel repairLower extremity, non-vein graft
35286 describes lower-extremity vessel repair using a graft other than a vein graft. This code describes direct repair.

Codes related to 35226

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

Codes related to 35226
CodeHow it relatesNational office range
Same family
35206Vessel repair, upper extremity, direct repairDirect vessel repair in the upper extremity rather than the lower extremity.No office rate
35207Vessel repair, direct repair, hand or fingerDirect repair specifically for a blood vessel in the hand or finger.No office rate
Used instead
35256Vessel repair, lower extremity, vein graftLower-extremity vessel repair using a vein graft rather than direct repair.No office rate
35286Vessel repair, lower extremity, non-vein graftLower-extremity vessel repair using a graft other than a vein graft.No office rate

35226 billing questions

When is this code selected instead of a graft-repair code?

Use this code when the operative documentation supports direct repair of a lower-extremity vessel. Repair using a vein graft or another graft points to a graft-repair code instead.

How does the lower-extremity site differ from 35206 or 35207?

This code is for a lower-extremity vessel. Code 35206 is for an upper-extremity vessel, while 35207 specifies a vessel in the hand or finger.

What documentation supports reporting this service?

The operative report should identify the repaired vessel and lower-extremity site, describe the defect or injury, and establish that the repair was direct rather than graft-based.

How is bilateral repair reported?

For bilateral procedures, report modifier 50; CMS pays the bilateral procedure at 150%.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

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 35226PPRRVU2026_Oct_nonQPP.csv, line 4,299 (RVU26D)

Open CMS sourceHow we calculate rates

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