No office rate
Use 35190 for an acquired extremity fistula; 35184 identifies a congenital extremity fistula.
On this page
CMS RVU26D · Effective 2026-10-01
35190 AV fistula repair Medicare reimbursement rates in Alabama
Reports operative repair of an acquired artery-to-vein connection in an extremity, such as a fistula resulting from trauma or a prior procedure. Compare 35190 office and facility rates across CMS payment localities in Alabama.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 35190 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$620.44
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Vascular surgery
About 35190: Acquired extremity arteriovenous fistula repair
Reports operative repair of an acquired artery-to-vein connection in an extremity, such as a fistula resulting from trauma or a prior procedure.
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.
CMS billing rules for 35190
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU13.08 · 64%
- Practice expense (office) RVU4.12 · 20%
- Malpractice RVU3.34 · 16%
213
Medicare services in 2024 · #4266 by national volume
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.
35190 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
Both codes concern acquired fistulas, but 35188 is for the head or neck rather than an extremity.
No office rate
Both codes concern acquired fistulas, but 35189 is for the thorax or abdomen rather than an extremity.
Compare 35190 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$620.44
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 35190 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
4,291
- Code
- 35190
- Physician work
- 13.08
- Practice expense
- 4.12
- Malpractice
- 3.34
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 13.08 | × 1.000 | 13.0800 |
| Practice expense | 4.12 | × 0.875 | 3.6050 |
| Malpractice | 3.34 | × 0.566 | 1.8904 |
| Total RVUs | 18.5754 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$620.44
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 13.08 | 1 |
| Practice expense | 4.12 | 0.875 |
| Malpractice | 3.34 | 0.566 |
(13.08 × 1 + 4.12 × 0.875 + 3.34 × 0.566) × $33.4009 = $620.44
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,28835184,,Rpr cgen av fistula xtr,A,,18.35,3.30,NA,3.30,,4.69,26.34,26.34,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,28935188,,Rpr acq av fistula head&neck,A,,17.55,12.86,NA,12.86,,7.41,37.82,37.82,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,29035189,,Rpr acq av fistula thrx&abd,A,,29.23,4.40,NA,4.40,,7.46,41.09,41.09,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,29135190,,Repair acq av fistula xtr,A,,13.08,4.12,NA,4.12,,3.34,20.54,20.54,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,29235201,,Repair blood vessel dir neck,A,,16.51,4.79,NA,4.79,,4.02,25.32,25.32,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,29335206,,Repair blood vessel dir uxtr,A,,13.49,5.06,NA,5.06,,3.13,21.68,21.68,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,29435207,,Rpr bld vsl dir hand finger,A,,10.67,7.73,NA,7.73,,2.06,20.46,20.46,0,090,0.09,0.84,0.07,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515