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CPT code 35686: Patency work2026 Medicare rate & RVUs

Additional vascular work to preserve bypass graft or arteriovenous fistula patency is reported with a qualifying primary procedure, not as a standalone service.

CMS RVU26DEffective Oct 1, 2026109 payment localities28 Medicare services in 2024

Medicare pays $145.29 for 35686 nationally in a facility.

Medicare rate · 35686

Patency work

Office or facility?

Work RVUs
3.26
Total RVUs
4.35
Global days
ZZZ

National rate · 2026

$145.29

Facility setting, before claim adjustments.

See every locality for 35686 →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 35686 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 35686 covers

This add-on represents work directed at maintaining patency of an existing bypass graft or arteriovenous fistula during a primary vascular operation. It is relevant when the surgeon addresses the graft or fistula as part of that operative service; the code is not a standalone report for routine surveillance or imaging. Vascular surgeons typically perform this work in an operating room or hospital procedure setting.

Report 35686 only with an eligible primary procedure, and document the existing graft or fistula, the patency-related work performed, and its relationship to the primary operation. CMS treats it as an add-on paid within the primary procedure’s global period. Do not report it by itself or as a separate later service during that global period. The operative note should make clear that the work concerns bypass graft or fistula patency rather than a separate access procedure.

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 35686 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

35686 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$132.18
AlaskaUnavailable$187.85
ArizonaUnavailable$141.03
ArkansasUnavailable$130.62
Atlanta, GAUnavailable$151.33
Austin, TXUnavailable$142.85
Bakersfield, CAUnavailable$137.36
Baltimore area, MDUnavailable$154.24
Beaumont, TXUnavailable$142.54
Brazoria, TXUnavailable$139.99

35686 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
35686 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 35686 rate is calculated

Each of 35686’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 · 35686

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.26

3.26 RVUs× 1.000 GPCI

Practice expense0.26

0.26 RVUs× 1.000 GPCI

Malpractice0.83

0.83 RVUs× 1.000 GPCI

Adjusted RVUs

4.3500

Conversion factor

$33.4009

Medicare rate

$145.29

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

Payment rules and modifiers for 35686

The CMS indicators that decide how 35686 is paid alongside other services.

CMS payment indicators · 35686

Patency work

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
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.

What modifiers do to the payment

Modifier 80 · payment effect

With and without the modifier

35686 without 80 · national facility

$145.29

Patency work

35686-80 · Assistant: 16%

$23.25

A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.

When to use modifier 80

35686 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 35686

    Patency work3.26 wRVU

    Not priced

  • 35685

    Bypass patch3.94 wRVU

    Not priced

  • 36832

    Fistula revision13.16 wRVU

    Not priced

  • 36833

    Fistula revision14.14 wRVU

    Not priced

How to choose

35685Bypass patch
Both are patency-related vascular codes, but 35685 concerns bypass graft patency with patch work; select based on the documented service.
36832Fistula revision
36832 describes revision of an arteriovenous access as a procedure. Code 35686 is an add-on for patency work reported with a primary procedure.
36833Fistula revision
36833 is an arteriovenous access revision that includes thrombectomy. Do not substitute it for 35686 based only on a general goal of maintaining patency.

Codes related to 35686

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

Codes related to 35686
CodeHow it relatesNational office range
Same family
35685Bypass patchA nearby patency-related bypass graft code; distinguish the work documented for each service.No office rate
Used instead
36832Fistula revisionUsed for surgical revision of an arteriovenous access rather than this add-on patency work.No office rate
36833Fistula revisionAddresses revision of an arteriovenous access with thrombectomy, a distinct access procedure.No office rate

35686 billing questions

Can 35686 be reported by itself?

No. CMS identifies it as an add-on code, so it must be reported with a qualifying primary procedure.

What should the operative note show?

Identify the existing bypass graft or arteriovenous fistula and describe the patency-related work and how it was performed with the primary operation.

Is this a code for routine fistula surveillance?

No. The code concerns operative patency work associated with a primary procedure, not routine monitoring or imaging.

How does the global period affect reporting?

CMS pays this add-on within the primary procedure’s global period. It is not separately reported as a standalone later service during that period.

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 35686PPRRVU2026_Oct_nonQPP.csv, line 4,402 (RVU26D)

Open CMS sourceHow we calculate rates

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