No office rate
Both are patency-related vascular codes, but 35685 concerns bypass graft patency with patch work; select based on the documented service.
On this page
CMS RVU26D · Effective 2026-10-01
35686 Patency work Medicare reimbursement rates in California
Additional vascular work to preserve bypass graft or arteriovenous fistula patency is reported with a qualifying primary procedure, not as a standalone service. Compare 35686 office and facility rates across CMS payment localities in California.
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 35686 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$135.12–$148.25
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $13.13 per service.
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.
Where 35686 pays more and less in California
Vascular surgery
About 35686: Bypass Graft or Fistula Patency Work
Additional vascular work to preserve bypass graft or arteriovenous fistula patency is reported with a qualifying primary procedure, not as a standalone service.
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.
CMS billing rules for 35686
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU3.26 · 75%
- Practice expense (office) RVU0.26 · 6%
- Malpractice RVU0.83 · 19%
28
Medicare services in 2024 · #5705 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.
35686 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
36832 describes revision of an arteriovenous access as a procedure. Code 35686 is an add-on for patency work reported with a primary procedure.
No office rate
36833 is an arteriovenous access revision that includes thrombectomy. Do not substitute it for 35686 based only on a general goal of maintaining patency.
Compare 35686 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.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office Unavailable | Facility $137.36 |
| Chico | Office Unavailable | Facility $135.12 |
| El Centro | Office Unavailable | Facility $135.25 |
| Fresno | Office Unavailable | Facility $135.12 |
| Hanford-Corcoran | Office Unavailable | Facility $135.12 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $142.03 |
| Madera | Office Unavailable | Facility $135.12 |
| Merced | Office Unavailable | Facility $135.12 |
| Modesto | Office Unavailable | Facility $135.12 |
| Napa | Office Unavailable | Facility $141.28 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $139.47 |
| Redding | Office Unavailable | Facility $135.12 |
| Rest Of California | Office Unavailable | Facility $135.12 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $144.01 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $137.77 |
| Salinas | Office Unavailable | Facility $137.19 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $137.57 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $144.20 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $143.26 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $148.25 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $144.39 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $135.49 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $136.58 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $136.92 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $137.68 |
| Stockton | Office Unavailable | Facility $135.12 |
| Vallejo | Office Unavailable | Facility $139.92 |
| Visalia | Office Unavailable | Facility $135.12 |
| Yuba City | Office Unavailable | Facility $135.12 |
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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 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.
4,39935682,,Composite byp grft 2 veins,A,,7.01,0.65,NA,0.65,,1.78,9.44,9.44,0,ZZZ,0.00,0.00,0.00,0,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,40035683,,Composite byp grft 3/> segmt,A,,8.28,0.66,NA,0.66,,2.11,11.05,11.05,0,ZZZ,0.00,0.00,0.00,0,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,40135685,,Bypass graft patency/patch,A,,3.94,0.39,NA,0.39,,1.02,5.35,5.35,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,40235686,,Bypass graft/av fist patency,A,,3.26,0.26,NA,0.26,,0.83,4.35,4.35,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,40335691,,Art trnsposj vertbrl carotid,A,,17.95,3.31,NA,3.31,,4.58,25.84,25.84,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,40435693,,Art trnsposj subclavian,A,,15.34,3.73,NA,3.73,,3.91,22.98,22.98,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,40535694,,Art trnsposj subclav carotid,A,,18.80,3.38,NA,3.38,,4.80,26.98,26.98,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00