Billing code 35686: Patency workMedicare rate & RVUs in Oklahoma
Additional vascular work to preserve bypass graft or arteriovenous fistula patency is reported with a qualifying primary procedure, not as a standalone service.
CMS doesn’t publish an office rate for 35686 in Oklahoma.
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 35686 covers
This add-on represents work directed at maintaining patency of an existing bypass graft or arteriovenous fistula during a primary vascular operation. It is relevant when the surgeon addresses the graft or fistula as part of that operative service; the code is not a standalone report for routine surveillance or imaging. Vascular surgeons typically perform this work in an operating room or hospital procedure setting.
Report 35686 only with an eligible primary procedure, and document the existing graft or fistula, the patency-related work performed, and its relationship to the primary operation. CMS treats it as an add-on paid within the primary procedure’s global period. Do not report it by itself or as a separate later service during that global period. The operative note should make clear that the work concerns bypass graft or fistula patency rather than a separate access procedure.
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.
35686 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | Unavailable | $138.18 |
How the 35686 rate is calculated
Each of 35686’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 · 35686
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.26Practice expense 0.26Malpractice 0.83
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 35686
The CMS indicators that decide how 35686 is paid alongside other services.
CMS payment indicators · 35686
Patency work
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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. |
What modifiers do to the payment
Modifier 80 · payment effect
With and without the modifier
35686 without 80 · national facility
$145.29
Patency work
35686-80 · Assistant: 16%
$23.25
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
35686 compared with similar codes
Compare codes
35686 vs 35685 vs 36832 vs 36833: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 35685Bypass patch
- Both are patency-related vascular codes, but 35685 concerns bypass graft patency with patch work; select based on the documented service.
- 36832Fistula revision
- 36832 describes revision of an arteriovenous access as a procedure. Code 35686 is an add-on for patency work reported with a primary procedure.
- 36833Fistula revision
- 36833 is an arteriovenous access revision that includes thrombectomy. Do not substitute it for 35686 based only on a general goal of maintaining patency.
35686 billing questions
Can 35686 be reported by itself?
No. CMS identifies it as an add-on code, so it must be reported with a qualifying primary procedure.
What should the operative note show?
Identify the existing bypass graft or arteriovenous fistula and describe the patency-related work and how it was performed with the primary operation.
Is this a code for routine fistula surveillance?
No. The code concerns operative patency work associated with a primary procedure, not routine monitoring or imaging.
How does the global period affect reporting?
CMS pays this add-on within the primary procedure’s global period. It is not separately reported as a standalone later service during that period.
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
Fee sheets
Put 35686 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →