CPT code 35226: Vessel repair, direct repair, lower extremity2026 Medicare rate & RVUs in California
Reports direct surgical repair of a blood vessel in the lower extremity, such as during treatment of a traumatic or operative vascular injury.
CMS doesn’t publish an office rate for 35226 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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On this page 9 sections
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 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 | $729.79 |
| Chico, CA | Unavailable | $719.65 |
| El Centro, CA | Unavailable | $720.27 |
| Fresno, CA | Unavailable | $719.65 |
| Hanford, CA | Unavailable | $719.65 |
| Los Angeles, CA | Unavailable | $759.20 |
| Madera, CA | Unavailable | $719.65 |
| Marin County, CA | Unavailable | $790.61 |
| Merced, CA | Unavailable | $719.65 |
| Modesto, CA | Unavailable | $719.65 |
| Napa, CA | Unavailable | $768.57 |
| Oxnard, CA | Unavailable | $747.46 |
| Redding, CA | Unavailable | $719.65 |
| Rest of California | Unavailable | $719.65 |
| Riverside, CA | Unavailable | $759.85 |
| Sacramento, CA | Unavailable | $738.02 |
| Salinas, CA | Unavailable | $735.00 |
| San Benito County, CA | Unavailable | $811.99 |
| San Diego, CA | Unavailable | $740.17 |
| San Francisco, CA | Unavailable | $786.36 |
| San Luis Obispo, CA | Unavailable | $725.36 |
| Santa Clara County, CA | Unavailable | $794.58 |
| Santa Cruz, CA | Unavailable | $737.46 |
| Santa Maria, CA | Unavailable | $734.43 |
| Santa Rosa, CA | Unavailable | $743.67 |
| Stockton, CA | Unavailable | $719.65 |
| Vallejo, CA | Unavailable | $762.44 |
| Visalia, CA | Unavailable | $719.65 |
| Yuba City, CA | Unavailable | $719.65 |
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
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
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 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.
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).
35226 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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