Billing code 35190: AV fistula repairMedicare rate & RVUs in Illinois
Reports operative repair of an acquired artery-to-vein connection in an extremity, such as a fistula resulting from trauma or a prior procedure.
CMS doesn’t publish an office rate for 35190 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 35190 covers
This code covers surgical repair of an acquired abnormal connection between an artery and a vein in an arm or leg. A vascular surgeon typically performs the operation in a hospital or other surgical facility, exposing and controlling the involved vessels before closing or reconstructing the communication. Acquired fistulas may follow trauma or a vascular intervention; the documented site and acquired nature distinguish this service from repair of a congenital fistula or one in another body region.
Report the code when the operative record supports repair of an acquired extremity fistula, including the affected vessels, location, and work performed. It has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate under the bilateral rule. An assistant at surgery may be paid; co-surgeons require 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 35190 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 | $834.27 |
| East St. Louis | Unavailable | $788.17 |
| Rest Of Illinois | Unavailable | $736.89 |
| Suburban Chicago | Unavailable | $778.95 |
How the 35190 rate is calculated
Each of 35190’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 · 35190
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 13.08Practice expense 4.12Malpractice 3.34
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 35190
35190 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 35190
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 · 35190
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
35190 without 51 · national facility
$686.05
AV fistula repair
35190-51 · Second procedure: 50%
$343.03
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%).
35190 compared with similar codes
Compare codes
35190 vs 35184 vs 35188 vs 35189: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 35184Fistula repair
- Use 35190 for an acquired extremity fistula; 35184 identifies a congenital extremity fistula.
- 35188AV fistula repair
- Both codes concern acquired fistulas, but 35188 is for the head or neck rather than an extremity.
- 35189AV fistula repair
- Both codes concern acquired fistulas, but 35189 is for the thorax or abdomen rather than an extremity.
35190 billing questions
How is this distinguished from 35184?
35190 is for repair of an acquired fistula in an extremity. 35184 is the corresponding code for a congenital extremity fistula.
Which documentation supports reporting 35190?
The operative report should identify the extremity site, the acquired fistula, the involved vessels, and the repair performed.
Can modifier 50 be used for bilateral repair?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate under that rule.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.
How does the multiple procedure rule affect payment?
When procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% 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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