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    v1.0.30
    OpenPayerBilling CodesArteriovenous Fistula Repair ProceduresCPT cpt-35188-arteriovenous-fistula-repair-head-neck
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    CPT 35188: Repair of Acquired or Traumatic Arteriovenous Fistula, Head/Neck

    Medicare pays $1265 on average nationally for this procedure.

    CPT code 35188 describes a surgical repair of an acquired or traumatic arteriovenous fistula via an incision in the head or neck; the service is a surgical vascular repair procedure typically performed in an operating room or other sterile surgical suite and involves direct exposure of the fistula with surgical closure or reconstruction of the abnormal arteriovenous connection.

    For related coverage guidance, see recent payer policy updates: Percutaneous Arteriovenous Fistula Creation, Dialysis Services (ESRD) Coverage and Provider Requirements, Total Parenteral Nutrition and Intradialytic Parenteral Nutrition.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult who presents with an acquired or traumatic arteriovenous fistula of the head or neck after penetrating trauma, prior surgery, or iatrogenic injury (for example, central line placement or catheter-related arterial puncture). The patient commonly has localized swelling, bruit, pulsatile mass, pain, skin changes, or neurologic symptoms from mass effect. Diagnostic workflow includes physical exam, duplex ultrasound, CT angiography or MR angiography to define the fistula and feeding/draining vessels, and vascular surgery consultation. The procedure 35188 is performed in an operating room or vascular interventional suite under general anesthesia or regional block. The surgeon makes a focused incision in the head or neck to expose the fistulous connection, isolates feeding artery(ies) and draining vein(s), and performs repair which may include vessel ligation, primary repair, patch angioplasty, or microsurgical techniques to restore normal vascular anatomy and eliminate shunt flow. Postoperative care includes monitoring in a PACU or inpatient setting for hemodynamic stability, wound care, vascular imaging as indicated, and follow-up with vascular surgery or neurosurgery depending on fistula location and complexity.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    61618Ligation of epidural artery or vein (intracranial)May be performed for intracranial arteriovenous fistula components when surgical ligation of feeding vessels is required; related when fistula extends intracranially.
    35181Repair of acquired or traumatic arteriovenous fistula; by direct suture of vessel(s)Alternative or adjacent technique code for AV fistula repair of extremities or neck depending on approach; selected when direct suture repair is performed and anatomy fits that code's intent.
    35820Ligation, open, intracranial vessels (e.g., external carotid branches)Used when additional ligation of feeding branches in the head/neck is required during the same operative session.
    36245Endovascular repair or occlusion of extracranial AV malformation, vessel catheterization and embolizationEndovascular embolization often precedes or complements open 35188 repair; performed by interventional radiology in the workflow.
    37718Ligation, traumatic arteriovenous fistula; by anastomosis or interposition graftApplicable for complex reconstructions requiring grafting of disrupted vessels when simple repair is not feasible.
    99100Anesthesia for patient of extreme age, younger than 1 or older than 70 years, requiring extraordinary servicesAncillary code sometimes used when high-risk anesthesia management is required for elderly or very young patients undergoing complex head/neck vascular procedures.

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    2084P0800X
    207R00000X
    207L00000X
    2086S0102X
    103TH0004X
    174M00000X
    152WS0006X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    D69.59Other secondary thrombocytopenia
    G45.9Transient cerebral ischemic attack, unspecified
    G46.3Brain stem stroke syndrome
    I60.9Nontraumatic subarachnoid hemorrhage, unspecified
    I61.9Nontraumatic intracerebral hemorrhage, unspecified
    I62.9Nontraumatic intracranial hemorrhage, unspecified
    I65.21Occlusion and stenosis of right carotid artery
    I65.29Occlusion and stenosis of unspecified carotid artery
    I67.4Hypertensive encephalopathy
    I68.8Other cerebrovascular disorders in diseases classified elsewhere

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Dialysis/Renal Replacement1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Arteriovenous Fistula CreationAmeriHealth Caritas2026-08-01
    Dialysis Services (ESRD) Coverage and Provider RequirementsMississippi Division of Medicaid2026-08-01
    Total Parenteral Nutrition and Intradialytic Parenteral NutritionCentene2026-05-01
    End Stage Renal Disease (ESRD): Renal Dialysispriority health2026-02-01
    Dialysis services (acute and chronic hemodialysis and peritoneal dialysis)UnitedHealthcare2026-01-01
    Home Hemodialysis (HHD) Coverage Criteriasierra health and life2026-01-01
    Home Hemodialysis (HHD) — Coverage CriteriaUnitedHealthcare2026-01-01
    Staff-Assisted Home HemodialysisCigna2025-11-15
    Parsabiv (etelcalcetide) Coverage for Secondary HyperparathyroidismMolina Healthcare2025-10-09
    DefenCath (taurolidine/heparin catheter lock) CoverageMass General Brigham Health Plan2025-09-01

    Related Codes

    CPT-35180-CONGENITAL-ARTERIOVENOUS-FISTULA-REPAIR-HEAD-NECK

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

    CPT-35182-CONGENITAL-ARTERIOVENOUS-FISTULA-REPAIR-ABDOMEN-THORAX

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

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

    CPT 35184: Repair of Congenital Arteriovenous Fistula, Extremity

    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

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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