Billing code 35180: AV fistula repairMedicare rate & RVUs in Illinois
Surgical repair of a congenital artery-to-vein fistula in the head or neck, reported when the surgeon treats the abnormal connection operatively.
CMS doesn’t publish an office rate for 35180 in Illinois.
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 35180 covers
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.
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.
Where 35180 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $883.26 |
| East St. Louis | Unavailable | $836.11 |
| Rest Of Illinois | Unavailable | $778.92 |
| Suburban Chicago | Unavailable | $819.96 |
How the 35180 rate is calculated
Each of 35180’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 · 35180
RVUs × geographic indexes × conversion factor
Work14.72
14.72 RVUs× 1.000 GPCI
Practice expense3.00
3.00 RVUs× 1.000 GPCI
Malpractice3.75
3.75 RVUs× 1.000 GPCI
Adjusted RVUs
21.4700
Conversion factor
$33.4009
Medicare rate
$717.12
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 35180
35180 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35180
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 · 35180
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
35180 without 51 · national facility
$717.12
AV fistula repair
35180-51 · Second procedure: 50%
$358.56
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%).
35180 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 35188AV fistula repair
- Both address a head or neck fistula, but 35180 is for congenital origin and 35188 is for acquired origin.
- 35182AV fistula repair
- Both are for congenital fistula repair; 35182 applies to the thorax or abdomen rather than the head or neck.
- 35184Fistula repair
- Both are for congenital fistula repair; 35184 applies to an extremity rather than the head or neck.
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 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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