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Billing code 35190: AV fistula repairMedicare rate & RVUs

Reports operative repair of an acquired artery-to-vein connection in an extremity, such as a fistula resulting from trauma or a prior procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities213 Medicare services in 2024

Medicare pays $686.05 for 35190 nationally in a facility.

Medicare rate · 35190

AV fistula repair

Swap in your local Medicare rate.

Work RVUs
13.08
Total RVUs
20.54
Global days
090

National rate · 2026

$686.05

Facility setting, before claim adjustments.

See every locality for 35190 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 35190 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 35190 covers

This code covers surgical repair of an acquired abnormal connection between an artery and a vein in an arm or leg. A vascular surgeon typically performs the operation in a hospital or other surgical facility, exposing and controlling the involved vessels before closing or reconstructing the communication. Acquired fistulas may follow trauma or a vascular intervention; the documented site and acquired nature distinguish this service from repair of a congenital fistula or one in another body region.

Report the code when the operative record supports repair of an acquired extremity fistula, including the affected vessels, location, and work performed. It has a 90-day global period, which includes 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% reduction. Modifier 50 is inappropriate under the bilateral rule. An assistant at surgery may be paid; co-surgeons require 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 35190 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

35190 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$620.44
Alaska*Unavailable$863.35
ArizonaUnavailable$665.72
ArkansasUnavailable$612.55
AtlantaUnavailable$711.99
AustinUnavailable$682.19
BakersfieldUnavailable$663.95
Baltimore/Surr. CntysUnavailable$729.53
BeaumontUnavailable$665.75
BrazoriaUnavailable$663.77

35190 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
35190 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 35190 rate is calculated

Each of 35190’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 · 35190

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 13.08Practice expense 4.12Malpractice 3.34

20.5400 adjusted RVUs×$33.4009 conversion factor=$686.05

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 35190

35190 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 35190

AV fistula repair

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)0The 150% bilateral adjustment doesn’t apply.
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 · 35190

AV fistula repair

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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 51 · payment effect

With and without the modifier

35190 without 51 · national facility

$686.05

AV fistula repair

35190-51 · Second procedure: 50%

$343.03

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%).

When to use modifier 51

35190 compared with similar codes

Compare codes

35190 vs 35184 vs 35188 vs 35189: national Medicare rates

Swap in your local Medicare rate.

  • 35190
    AV fistula repair · 13.08 wRVU
    —
  • 35184
    Fistula repair · 18.35 wRVU
    —
  • 35188
    AV fistula repair · 17.55 wRVU
    —
  • 35189
    AV fistula repair · 29.23 wRVU
    —

How to choose

35184Fistula repair
Use 35190 for an acquired extremity fistula; 35184 identifies a congenital extremity fistula.
35188AV fistula repair
Both codes concern acquired fistulas, but 35188 is for the head or neck rather than an extremity.
35189AV fistula repair
Both codes concern acquired fistulas, but 35189 is for the thorax or abdomen rather than an extremity.

Codes related to 35190

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

Codes related to 35190
CodeHow it relatesNational office range
Same family
35184Fistula repairRepair of a congenital, rather than acquired, arteriovenous fistula in an extremity.No office rate
35188AV fistula repairRepair of an acquired arteriovenous fistula in the head or neck.No office rate
35189AV fistula repairRepair of an acquired arteriovenous fistula in the thorax or abdomen.No office rate

35190 billing questions

How is this distinguished from 35184?

35190 is for repair of an acquired fistula in an extremity. 35184 is the corresponding code for a congenital extremity fistula.

Which documentation supports reporting 35190?

The operative report should identify the extremity site, the acquired fistula, the involved vessels, and the repair performed.

Can modifier 50 be used for bilateral repair?

No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate under that rule.

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 reported?

An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.

How does the multiple procedure rule affect payment?

When procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% 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
RVUs for 35190PPRRVU2026_Oct_nonQPP.csv, line 4,291 (RVU26D)

Open CMS sourceHow we calculate rates

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