Billing code 35188: AV fistula repairMedicare rate & RVUs in Guam
Reports operative repair of an acquired abnormal artery-to-vein connection in the head or neck, rather than a congenital fistula or one at another site.
CMS doesn’t publish an office rate for 35188 in Guam.
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 9 sections
What 35188 covers
A vascular surgeon typically reports this service for operative treatment of an acquired arteriovenous fistula in the head or neck, such as one resulting from trauma or a prior procedure. The surgeon exposes the abnormal connection and repairs it to interrupt the direct flow between artery and vein. The service is generally performed in a hospital operating room.
Select the code when the operative record supports an acquired fistula and identifies its head-and-neck location; congenital fistulas and fistulas in the thorax, abdomen, or extremities have different codes. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is not appropriate for this repair. Assistant-at-surgery payment may be available; co-surgeon payment requires 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.
35188 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $1,217.87 |
How the 35188 rate is calculated
Each of 35188’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 · 35188
RVUs × geographic indexes × conversion factor
Work17.55
17.55 RVUs× 1.000 GPCI
Practice expense12.86
12.86 RVUs× 1.000 GPCI
Malpractice7.41
7.41 RVUs× 1.000 GPCI
Adjusted RVUs
37.8200
Conversion factor
$33.4009
Medicare rate
$1,263.22
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 35188
35188 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35188
AV fistula repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 35188
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
35188 without 51 · national facility
$1,263.22
AV fistula repair
35188-51 · Second procedure: 50%
$631.61
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%).
35188 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 35180AV fistula repair
- Both codes concern a head-and-neck arteriovenous fistula; choose 35188 for an acquired fistula and 35180 for a congenital one.
- 35189AV fistula repair
- This code describes acquired fistula repair in the thorax or abdomen, not the head and neck.
- 35190AV fistula repair
- This code describes acquired fistula repair in an extremity; 35188 is for the head and neck.
35188 billing questions
How is this code distinguished from 35180?
35188 is for an acquired head-and-neck fistula. 35180 is the corresponding code for a congenital fistula in that region.
Which code applies when the acquired fistula is outside the head and neck?
Use the acquired-fistula code matching the documented location: 35189 for the thorax or abdomen, or 35190 for an extremity.
What documentation supports reporting 35188?
The operative report should establish that the fistula is acquired, identify its head-and-neck location, and describe the repair performed.
Are related postoperative visits included?
Yes. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used, and what about assistant or co-surgeon billing?
Modifier 50 is not appropriate for this repair. Assistant-at-surgery payment may be available, while co-surgeon payment requires supporting documentation.
How are other procedures performed in the same session paid?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard multiple-procedure 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
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