No office rate
Both concern lower-extremity vessel repair. Choose 35226 when the repair is direct and does not use a graft; choose this code when a vein graft is used.
On this page
CMS RVU26D · Effective 2026-10-01
35256 Vessel repair Medicare reimbursement rates in Hawaii
Report this operation when a surgeon repairs a lower-extremity blood vessel using a vein graft to restore continuity across a defect. Compare 35256 office and facility rates across CMS payment localities in Hawaii.
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 35256 in Hawaii?
Hawaii 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
$885.35
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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 35256: Lower-extremity vessel repair with vein graft
Report this operation when a surgeon repairs a lower-extremity blood vessel using a vein graft to restore continuity across a defect.
A surgeon uses this service to reconstruct a blood vessel in the lower limb with a vein graft, such as when an injury or a segmental defect prevents repair by direct suturing. It is typically performed in an operating room by a vascular, trauma, or other surgeon treating the affected vessel. The operative report should identify the lower-extremity site and vessel, describe the defect and repair technique, and document use of a vein graft.
Choose this code for a vein-graft repair in the lower extremity; direct vessel repair is represented by a different code, and repairs using other graft material have a separate code. CMS classifies the service as major surgery with a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 35256
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU18.58 · 67%
- Practice expense (office) RVU4.67 · 17%
- Malpractice RVU4.52 · 16%
209
Medicare services in 2024 · #4285 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.
35256 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
Both describe vessel repair with a vein graft, but 35236 is for the upper extremity; this code is for the lower extremity.
No office rate
Both are for lower-extremity vessel repair with a graft. The distinction is graft material: vein for this code, other graft material for 35286.
Compare 35256 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
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$885.35
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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 35256 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
4,305
- Code
- 35256
- Physician work
- 18.58
- Practice expense
- 4.67
- Malpractice
- 4.52
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 18.58 | × 1.000 | 18.5800 |
| Practice expense | 4.67 | × 1.137 | 5.3098 |
| Malpractice | 4.52 | × 0.579 | 2.6171 |
| Total RVUs | 26.5069 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$885.35
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 18.58 | 1 |
| Practice expense | 4.67 | 1.137 |
| Malpractice | 4.52 | 0.579 |
(18.58 × 1 + 4.67 × 1.137 + 4.52 × 0.579) × $33.4009 = $885.35
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.
35256 billing questions
When should this be chosen instead of direct vessel repair?
Use this code when the lower-extremity vessel repair uses a vein graft. A direct repair without a graft is represented by 35226.
Is this a bypass code?
No. It represents repair of a lower-extremity vessel using a vein graft, rather than a bypass procedure.
How should bilateral repairs be reported?
For a bilateral procedure, report modifier 50; CMS pays this service at 150% under the supplied fee schedule rule.
What operative documentation supports this code?
Document the lower-extremity vessel and site, the defect or injury, the repair performed, and that a vein graft was used.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and related postoperative care during the 90-day period are included in the global service.
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.
4,30235241,,Rpr blvsl vn grf ntrthrc w/b,A,,24.94,10.10,NA,10.10,,5.98,41.02,41.02,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,30335246,,Rpr blvsl vn grf ntrthrc w/o,A,,27.52,10.32,NA,10.32,,6.59,44.43,44.43,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,30435251,,Rpr blvsl vn grf intra-abdl,A,,31.11,7.91,NA,7.91,,7.85,46.87,46.87,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,30535256,,Repair blvsl vn grf lxtr,A,,18.58,4.67,NA,4.67,,4.52,27.77,27.77,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,30635261,,Rpr blvsl grf oth/thn vn nck,A,,18.49,3.65,NA,3.65,,4.73,26.87,26.87,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,30735266,,Rpr blvsl grf oth/th vn uxtr,A,,15.43,4.24,NA,4.24,,3.92,23.59,23.59,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,30835271,,Rpr blvs gr ot/th vn ntrth w,A,,23.97,9.89,NA,9.89,,5.73,39.59,39.59,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014