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    v1.0.30
    OpenPayerBilling CodesArteriovenous Fistula Repair ProceduresCPT cpt-35189-thoracic-or-abdominal-av-fistula-repair
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    CPT 35189: Repair of Acquired or Traumatic Arteriovenous Fistula

    Medicare pays $1370 on average nationally for this procedure.

    CPT code 35189 describes a surgical procedure in which the provider makes an incision in the thorax or abdomen to approach and repair an acquired or traumatic arteriovenous fistula, representing an open surgical repair service; service type: surgical repair of arteriovenous fistula; typical site of service: inpatient or outpatient operating room within a hospital or surgical center where thoracic or abdominal access is required.

    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 58-year-old male presents to the vascular surgery service with an acquired arteriovenous fistula of the chest wall after penetrating trauma that resulted in a palpable thrill, localized pain, progressive venous engorgement, and a new systolic bruit. Imaging with CT angiography confirms a traumatic arteriovenous communication between a branch of the subclavian artery and adjacent vein within the thorax. The patient is evaluated preoperatively, informed consent is obtained, and standard pre-op labs and crossmatching are completed. In the operating room under general anesthesia, the surgeon makes a thoracic approach incision, isolates the fistulous tract, controls inflow and outflow vessels, and performs open repair of the fistula with direct suture repair and vessel reconstruction as indicated. Postoperative care includes hemodynamic monitoring, wound care, and vascular imaging or duplex ultrasound to confirm fistula closure and limb perfusion prior to discharge. Typical site of service is an inpatient hospital operating room or ambulatory surgery center when clinically appropriate. Typical service type is an open surgical vascular repair procedure.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    35800Open repair of traumatic injury to thoracic aorta; direct suture or patch graftMay be required when concomitant major thoracic vascular injury is present and requires open repair during the same operative episode
    35631Ligation, open, of intrathoracic vessel(s)Performed when simple ligation of feeding vessels is chosen instead of complex repair
    36200Selective catheter placement, arterial, non-coronary, diagnosticUsed preoperatively for angiography to map the fistula's arterial supply
    75894Transcatheter therapy, arterial, percutaneous; radiological supervision and interpretationUsed when endovascular embolization is performed as an adjunct or alternative to open repair
    99152Moderate sedation services provided by the same physician performing a diagnostic or therapeutic service (initial 15 minutes)May be reported in certain settings if monitored anesthesia care or sedation services are provided intraoperatively

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    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…
    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…
    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…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2080P0206X
    207K00000X
    1835G0000X
    156FX1800X
    2085D0003X
    2472D0500X
    225XF0002X
    2084N0008X

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

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

    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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