CPT 35180 Repair of Congenital AVF — Reimbursement | OpenPayer

Summary & Overview

CPT 35180: Repair of Congenital Arteriovenous Fistula, Head and Neck

CPT code 35180 identifies surgical repair of a congenital arteriovenous fistula in the head and neck. This code captures a focused vascular surgical approach to correct abnormal arterial-to-venous connections present at birth, typically performed in an operating room or ambulatory surgical center. Nationally, accurate use of this CPT code supports appropriate clinical documentation, procedure classification, and payment for complex head and neck vascular procedures.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and the typical setting for this service, plus guidance on common payer coverage expectations where available. The publication outlines benchmarks for coding and utilization, highlights relevant policy considerations that affect authorization and payment, and situates the procedure within broader vascular and head-and-neck surgical care pathways.

This summary is intended for clinicians, coding professionals, and policy analysts seeking a clear description of the code, its clinical context, and the payer landscape at a national level. Data not available in the input will be noted in the detailed sections of the full publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35180CPTvascular surgeryhead and neck surgeryarteriovenous fistulasurgical repairoperating roomambulatory surgical center

Billing Code Overview

CPT code 35180 describes a surgical procedure in which the provider makes an incision to approach a congenital arteriovenous fistula in the head and neck region and performs repair of the fistula. This procedure is a vascular surgery intervention focused on correcting abnormal connections between arteries and veins present from birth.

Service type: Surgical repair of congenital arteriovenous fistula
Typical site of service: Operating room or surgical suite in a hospital or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A typical patient is a child or young adult presenting with a congenital arteriovenous fistula (AVF) of the head or neck region causing symptoms such as a pulsatile mass, bruit, focal pain, progressive cosmetic deformity, or neurologic signs from mass effect or venous hypertension. Diagnostic workup includes history and focused head and neck exam, duplex ultrasound, CT angiography or MR angiography, and diagnostic cerebral or head/neck angiography to define feeding arteries, nidus, and venous drainage. The surgical team (often a vascular neurosurgeon, otolaryngologist, or vascular surgeon) plans an open operative approach when endovascular therapy is not feasible or as a staged hybrid with embolization.

Preoperative workflow includes consent, preop imaging review, anesthesia evaluation, and marking of the incision site. Intraoperatively, the provider makes a targeted incision to expose the AVF in the head or neck, isolates feeding vessels, and performs vessel ligation, direct repair, or resection of the fistulous segment; adjunctive microvascular techniques or intraoperative angiography may be used to confirm obliteration. Postoperative care involves neurovascular monitoring, wound care, pain control, and follow-up angiography or imaging to confirm durable obliteration and assess for recurrence. Typical length of stay varies from same-day observation for select minor exposures to several days for complex repairs with monitoring.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

CPT 35182: Repair of Congenital Arteriovenous Fistula, Abdomen or Thorax

CPT-35189-THORACIC-OR-ABDOMINAL-AV-FISTULA-REPAIR

CPT 35189: Repair of Acquired or Traumatic Arteriovenous Fistula

CPT-35190-ARTERIOVENOUS-FISTULA-REPAIR-EXTREMITY

CPT 35190: Repair of Arteriovenous Fistula in Extremity

CPT-35184-CONGENITAL-ARTERIOVENOUS-FISTULA-REPAIR-EXTREMITY

CPT 35184: Repair of Congenital Arteriovenous Fistula, Extremity

CPT-35188-ARTERIOVENOUS-FISTULA-REPAIR-HEAD-NECK

CPT 35188: Repair of Acquired or Traumatic Arteriovenous Fistula, Head/Neck

Taxonomy Code	Specialty	Notes
207L00000X	Vascular Surgery	Vascular surgeons perform open repair of head/neck AVFs when vascular expertise is required.
2084P0800X	Neurological Surgery	Neurosurgeons manage intracranial or skull base AVFs and complex head/neck fistulas with neurosurgical techniques.
207P00000X	Otolaryngology (ENT)	Otolaryngologists (head and neck surgeons) address superficial head/neck AVFs involving soft tissues of the neck and face.
208000000X	General Surgery	General surgeons with vascular experience may perform open repairs in selected cases.
207RH0000X	Plastic and Reconstructive Surgery	Plastic surgeons may participate for complex reconstructions after resection or to optimize cosmetic outcomes.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q28.3`	Arteriovenous malformation of cerebral vessels	Congenital arteriovenous shunts in the head that may present as AVF requiring surgical repair.
`Q28.8`	Other congenital malformations of peripheral vascular system	Includes congenital vascular anomalies in the head/neck region presenting as fistulae.
`I77.6`	Arteriovenous fistula, acquired	Relevant when distinguishing congenital AVF from acquired lesions; sometimes used if coding practice varies.
`I72.8`	Other aneurysm and dissection of other specified arteries	Included when arterial feeders have aneurysmal change requiring repair during AVF surgery.
`R02`	Gangrene, not elsewhere classified	Rarely relevant but included when tissue ischemia or necrosis accompanies high-flow fistulae in the head/neck.
`H05.2`	Orbital vascular malformations	Relevant for AVFs involving the orbit that require open surgical management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61624`	Excision or repair of intracranial arteriovenous malformation; simple	Related when intracranial AV shunts are approached or resected; applicable if fistula has intracranial extension.
`35820`	Ligation and division of a major neck vessel (e.g., carotid artery)	May be performed if arterial feeders require control or sacrifice during open fistula repair.
`61790`	Stereotactic radiosurgery, per lesion (e.g., Gamma Knife)	Adjunctive or alternate therapy for residual fistula not amenable to open repair or endovascular occlusion.
`61645`	Ligation or occlusion of cerebral venous structure (e.g., superior sagittal sinus)	Applicable when venous drainage requires surgical modification as part of complex AVF management.
`61796`	Intracranial embolization, therapeutic, per session	Often performed endovascularly before or after open repair in a hybrid approach to reduce flow or obliterate feeders.
`61680`	Surgical repair of dural arteriovenous fistula	Related procedure for dural AVFs of the cranial vault that may require similar exposure and repair techniques.

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