No office rate
Both codes concern a head-and-neck arteriovenous fistula; choose 35188 for an acquired fistula and 35180 for a congenital one.
On this page
CMS RVU26D · Effective 2026-10-01
35188 AV fistula repair Medicare reimbursement rates in Pennsylvania
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. Compare 35188 office and facility rates across CMS payment localities in Pennsylvania.
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 35188 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1214.39–$1339.15
2 of 2 localities have a supported rate.
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 35188: Acquired head and neck arteriovenous fistula repair
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.
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.
CMS billing rules for 35188
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU17.55 · 46%
- Practice expense (office) RVU12.86 · 34%
- Malpractice RVU7.41 · 20%
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 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
This code describes acquired fistula repair in the thorax or abdomen, not the head and neck.
No office rate
This code describes acquired fistula repair in an extremity; 35188 is for the head and neck.
Compare 35188 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$1339.15
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$1214.39
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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 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.
4,28635180,,Rpr cgen av fistula head&nck,A,,14.72,3.00,NA,3.00,,3.75,21.47,21.47,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,28735182,,Rpr cgen av fistula thrx&abd,A,,30.92,11.85,NA,11.85,,7.78,50.55,50.55,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,28835184,,Rpr cgen av fistula xtr,A,,18.35,3.30,NA,3.30,,4.69,26.34,26.34,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,28935188,,Rpr acq av fistula head&neck,A,,17.55,12.86,NA,12.86,,7.41,37.82,37.82,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,29035189,,Rpr acq av fistula thrx&abd,A,,29.23,4.40,NA,4.40,,7.46,41.09,41.09,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,29135190,,Repair acq av fistula xtr,A,,13.08,4.12,NA,4.12,,3.34,20.54,20.54,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,29235201,,Repair blood vessel dir neck,A,,16.51,4.79,NA,4.79,,4.02,25.32,25.32,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00