No office rate
Both address a head or neck fistula, but 35180 is for congenital origin and 35188 is for acquired origin.
On this page
CMS RVU26D · Effective 2026-10-01
35180 AV fistula repair Medicare reimbursement rates in Delaware
Surgical repair of a congenital artery-to-vein fistula in the head or neck, reported when the surgeon treats the abnormal connection operatively. Compare 35180 office and facility rates across CMS payment localities in Delaware.
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 35180 in Delaware?
Delaware 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
$705.72
1 of 1 localities have a supported rate.
Payment area: Delaware
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 35180: Congenital head and neck AV fistula repair
Surgical repair of a congenital artery-to-vein fistula in the head or neck, reported when the surgeon treats the abnormal connection operatively.
35180 describes operative repair of a congenital arteriovenous fistula located in the head or neck. The surgeon treats an abnormal artery-to-vein connection that has been present since birth; the operation may involve interrupting the connection and addressing the involved vessels. Vascular surgeons and other surgeons managing head and neck vascular lesions may perform the procedure in a hospital operating room.
Report this code when the documented lesion is congenital, is in the head or neck, and is surgically repaired. The operative report should support the lesion’s origin, location, and repair performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in one session, the highest-valued is paid in full and the others at 50%. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 35180
- 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 RVU14.72 · 69%
- Practice expense (office) RVU3.00 · 14%
- Malpractice RVU3.75 · 17%
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.
35180 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
Both are for congenital fistula repair; 35182 applies to the thorax or abdomen rather than the head or neck.
No office rate
Both are for congenital fistula repair; 35184 applies to an extremity rather than the head or neck.
Compare 35180 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
Delaware →
Office / nonfacility
Unavailable
Facility
$705.72
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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 35180 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
4,286
- Code
- 35180
- Physician work
- 14.72
- Practice expense
- 3.00
- Malpractice
- 3.75
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.72 | × 1.005 | 14.7936 |
| Practice expense | 3.00 | × 0.988 | 2.9640 |
| Malpractice | 3.75 | × 0.899 | 3.3712 |
| Total RVUs | 21.1288 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$705.72
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.72 | 1.005 |
| Practice expense | 3 | 0.988 |
| Malpractice | 3.75 | 0.899 |
(14.72 × 1.005 + 3 × 0.988 + 3.75 × 0.899) × $33.4009 = $705.72
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.
35180 billing questions
How do I distinguish 35180 from 35188?
Use 35180 for a congenital fistula in the head or neck. Code 35188 describes repair of an acquired fistula at that location.
Which code applies when the congenital fistula is outside the head and neck?
Choose the congenital fistula code for the documented site: 35182 for the thorax or abdomen, or 35184 for an extremity.
Is modifier 50 appropriate for bilateral repair?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
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.
4,28335152,,Repair ruptd popliteal art,A,,26.97,4.21,NA,4.21,,6.87,38.05,38.05,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,2843515F,,Pt has docd immun to hep c,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,2853517F,,Hbv assess&results intrp 1yr,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,28635180,,Rpr cgen av fistula head&nck,A,,14.72,3.00,NA,3.00,,3.75,21.47,21.47,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,28735182,,Rpr cgen av fistula thrx&abd,A,,30.92,11.85,NA,11.85,,7.78,50.55,50.55,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,28835184,,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
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503