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CPT code 35256: Vessel repair, lower extremity, vein graft2026 Medicare rate & RVUs

Report this operation when a surgeon repairs a lower-extremity blood vessel using a vein graft to restore continuity across a defect.

CMS RVU26DEffective Oct 1, 2026109 payment localities209 Medicare services in 2024

Medicare pays $927.54 for 35256 nationally in a facility.

Medicare rate · 35256

Vessel repair, lower extremity, vein graft

Office or facility?

Work RVUs
18.58
Total RVUs
27.77
Global days
090

National rate · 2026

$927.54

Facility setting, before claim adjustments.

See every locality for 35256 →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 35256 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 35256 covers

A surgeon uses this service to reconstruct a blood vessel in the lower limb with a vein graft, such as when an injury or a segmental defect prevents repair by direct suturing. It is typically performed in an operating room by a vascular, trauma, or other surgeon treating the affected vessel. The operative report should identify the lower-extremity site and vessel, describe the defect and repair technique, and document use of a vein graft.

Choose this code for a vein-graft repair in the lower extremity; direct vessel repair is represented by a different code, and repairs using other graft material have a separate code. CMS classifies the service as major surgery with a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with 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 35256 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

35256 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$842.52
AlaskaUnavailable$1,180.19
ArizonaUnavailable$900.97
ArkansasUnavailable$832.33
Atlanta, GAUnavailable$962.25
Austin, TXUnavailable$920.62
Bakersfield, CAUnavailable$895.28
Baltimore area, MDUnavailable$984.64
Beaumont, TXUnavailable$902.79
Brazoria, TXUnavailable$897.89

35256 rates by state

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

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Explore a state

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
35256 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 35256 rate is calculated

Each of 35256’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 · 35256

RVUs × geographic indexes × conversion factor

Office or facility?

Work18.58

18.58 RVUs× 1.000 GPCI

Practice expense4.67

4.67 RVUs× 1.000 GPCI

Malpractice4.52

4.52 RVUs× 1.000 GPCI

Adjusted RVUs

27.7700

Conversion factor

$33.4009

Medicare rate

$927.54

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

Payment rules and modifiers for 35256

35256 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 35256

Vessel repair, lower extremity, vein graft

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 · 35256

Vessel repair, lower extremity, vein graft

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

35256 without 50 · national facility

$927.54

Vessel repair, lower extremity, vein graft

35256-50 · Bilateral: 150%

$1,391.31

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

35256 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 35256

    Vessel repair, lower extremity, vein graft18.58 wRVU

    Not priced

  • 35226

    Vessel repair, direct repair, lower extremity14.92 wRVU

    Not priced

  • 35236

    Vessel repair, upper extremity, vein graft17.57 wRVU

    Not priced

  • 35286

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

    Not priced

How to choose

35226Vessel repairDirect repair, lower extremity
Both concern lower-extremity vessel repair. Choose 35226 when the repair is direct and does not use a graft; choose this code when a vein graft is used.
35236Vessel repairUpper extremity, vein graft
Both describe vessel repair with a vein graft, but 35236 is for the upper extremity; this code is for the lower extremity.
35286Vessel repairLower extremity, non-vein graft
Both are for lower-extremity vessel repair with a graft. The distinction is graft material: vein for this code, other graft material for 35286.

Codes related to 35256

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

Codes related to 35256
CodeHow it relatesNational office range
Used instead
35226Vessel repair, direct repair, lower extremityLower-extremity vessel repair by direct technique, rather than with a vein graft.No office rate
35286Vessel repair, lower extremity, non-vein graftLower-extremity vessel repair using graft material other than vein.No office rate
Same family
35236Vessel repair, upper extremity, vein graftVein-graft repair in the upper extremity; the anatomic region differs.No office rate
35251Vessel repair, intra-abdominal vein graftVein-graft repair of an intra-abdominal vessel; the anatomic region differs.No office rate

35256 billing questions

When should this be chosen instead of direct vessel repair?

Use this code when the lower-extremity vessel repair uses a vein graft. A direct repair without a graft is represented by 35226.

Is this a bypass code?

No. It represents repair of a lower-extremity vessel using a vein graft, rather than a bypass procedure.

How should bilateral repairs be reported?

For a bilateral procedure, report modifier 50; CMS pays this service at 150%.

What operative documentation supports this code?

Document the lower-extremity vessel and site, the defect or injury, the repair performed, and that a vein graft was used.

How does the 90-day global period affect postoperative billing?

The day-before preoperative visit and related postoperative care during the 90-day period are included in the global service.

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 35256PPRRVU2026_Oct_nonQPP.csv, line 4,305 (RVU26D)

Open CMS sourceHow we calculate rates

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