CPT 35188 Arteriovenous Fistula Repair Reimbursement | OpenPayer

Summary & Overview

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

CPT code 35188 represents surgical repair of an acquired or traumatic arteriovenous fistula of the head or neck, performed through an incision to directly access and repair the abnormal connection between an artery and vein. Nationally, this code captures procedures that address potentially serious vascular injuries or complications affecting cerebral or cervical circulation and informs payment, quality measurement, and utilization monitoring across acute and ambulatory surgical settings.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, and the scope of services represented by the code. The publication also summarizes benchmarks and payer coverage considerations where available, highlights relevant coding and billing contexts for hospital and ambulatory settings, and outlines areas for policy attention such as utilization trends and reimbursement alignment. National stakeholders — including hospital administrators, vascular and head & neck surgeons, and coding professionals — will gain a clear understanding of what CPT code 35188 denotes, why it matters for care delivery and billing, and which payers commonly encounter claims for this service.

Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and payer-specific reimbursement details.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35188CPTarteriovenous fistula repairvascular surgeryhead and neck surgeryambulatory surgeryhospital inpatientprocedure coding

Billing Code Overview

CPT code 35188 describes a surgical procedure in which the provider makes an incision in the head or neck to approach an acquired or traumatic arteriovenous fistula and repairs the fistula. This procedure is a surgical repair of arteriovenous fistula in the head or neck region.

Service type: Surgical repair / vascular surgery

Typical site of service: Hospital inpatient or outpatient surgical setting, or ambulatory surgery center, depending on clinical severity and institutional practice.

Data not available in the input.

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.

Coding Specifications

Modifier	Description	When to Use
`51`	Multiple procedures	When `35188` is billed on the same day with other distinct procedures by the same provider (use per payer rules).

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

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

CPT-35190-ARTERIOVENOUS-FISTULA-REPAIR-EXTREMITY

CPT 35190: Repair of Arteriovenous Fistula in Extremity

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

CPT 35189: Repair of Acquired or Traumatic Arteriovenous Fistula

Taxonomy Code	Specialty	Notes
`208000000X`	Vascular Surgery	Primary specialty performing AV fistula repairs of head and neck.
`2084P0800X`	Neurosurgery	Performs complex cranial or skull base vascular fistula repairs.
`207R00000X`	Thoracic Surgery	Involved when cervicothoracic vascular access or proximal great vessel repair is required.
`207L00000X`	General Surgery	May perform head/neck vascular repairs in some settings or trauma cases.
`2086S0102X`	Interventional Radiology	Provides endovascular evaluation and adjunctive procedures; may collaborate but typically not for open `35188` repair.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S25.121A`	Traumatic injury of right carotid artery	Traumatic carotid injuries can produce arteriovenous fistulae in the neck requiring open repair.
`S25.122A`	Traumatic injury of left carotid artery	As above for left-sided injuries leading to fistula formation.
`I77.6`	Arteriovenous malformation of peripheral vessels	Represents acquired AV malformations that can present in head/neck and require surgical correction.
`I98.8`	Other specified postprocedural disorders of circulatory system	Postprocedural fistula formation after vascular access or surgery in the head/neck region.
`T81.89XA`	Other complications of procedures, not elsewhere classified, initial encounter	Used for complications such as iatrogenic fistula following central line placement or cervical surgery.
`S14.02XA`	Injury of blood vessels at neck level, unspecified, initial encounter	General injury code for neck vessel trauma that may lead to an AV fistula.
`I60.9`	Subarachnoid hemorrhage, unspecified	Included when presentation includes hemorrhage from ruptured vascular lesions associated with fistulae (context-dependent).

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61618`	Ligation 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.
`35181`	Repair 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.
`35820`	Ligation, 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.
`36245`	Endovascular repair or occlusion of extracranial AV malformation, vessel catheterization and embolization	Endovascular embolization often precedes or complements open `35188` repair; performed by interventional radiology in the workflow.
`37718`	Ligation, traumatic arteriovenous fistula; by anastomosis or interposition graft	Applicable for complex reconstructions requiring grafting of disrupted vessels when simple repair is not feasible.
`99100`	Anesthesia for patient of extreme age, younger than 1 or older than 70 years, requiring extraordinary services	Ancillary code sometimes used when high-risk anesthesia management is required for elderly or very young patients undergoing complex head/neck vascular procedures.

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