CPT 35190 Arteriovenous Fistula Repair Reimbursement | OpenPayer

Summary & Overview

CPT 35190: Repair of Arteriovenous Fistula in Extremity

CPT code 35190 denotes the surgical repair of an arteriovenous fistula in an extremity, a targeted vascular procedure to correct abnormal connections between arteries and veins that arise from trauma or congenital causes. Nationally, this code is used in both inpatient and outpatient surgical settings and matters for clinicians, hospitals, and payers because it captures a specialized vascular repair that can affect resource use, operative time, and postprocedural care needs. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the primary payer landscape. The publication summarizes common billing considerations and outlines available national benchmarks where present; if specific comparative data are not provided, it notes that data are not available in the input. The content highlights coding scope, expected service setting, and the clinical indication for repair of traumatic or congenital arteriovenous fistulas in extremities. This piece is intended to inform coding professionals, vascular surgeons, billing teams, and policy analysts about the clinical and billing identity of CPT code 35190 and what to expect when this code is used in national practice.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare35190CPTvascular-surgeryarteriovenous-fistulaextremity-surgerysurgical-repairoperating-roomambulatory-surgery-center

Billing Code Overview

CPT code 35190 describes a surgical repair of an arteriovenous fistula in an extremity. The procedure involves making an incision at the site of the fistula in the affected limb and repairing the fistula that developed due to trauma or other causes present after birth. This code applies to procedures that directly address the vascular connection between an artery and vein in an extremity.

Service type: Surgical repair of arteriovenous fistula
Typical site of service: Hospital operating room or ambulatory surgical center, with the procedure performed on an extremity

Clinical & Coding Specifications

Clinical Context

A 32-year-old patient presents to the outpatient vascular surgery clinic after sustaining blunt trauma to the forearm during a motor vehicle collision. On examination there is a pulsatile swelling with a bruit and progressively worsening distal numbness. Duplex ultrasound confirms disruption of an existing arteriovenous fistula in the forearm with active flow between the artery and vein and surrounding hematoma. The surgical team schedules a procedure to expose the fistula through an incision at the extremity, evacuate hematoma, and perform repair of the fistula and associated vessel injury.

Preoperative workflow includes history and focused vascular exam, review of imaging (duplex ultrasound or CT angiography), informed consent, anesthesia evaluation (often regional block or general anesthesia), marking of the operative site, and preoperative antibiotics per facility protocol. Intraoperative steps include limb tourniquet if indicated, incision directly over the fistula, identification of arterial and venous structures, control of proximal and distal vessels, repair or reconstruction of the fistulous tract (primary repair, patch angioplasty, or vein graft depending on defect), hemostasis, and layered wound closure. Postoperative care includes neurovascular checks, analgesia, wound care instructions, and short-term follow-up with duplex study to confirm patency and absence of recurrence.

Coding Specifications

Modifier	Description	When to Use
`11`	Service performed in addition to other procedural services (default)

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

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

CPT 35189: Repair of Acquired or Traumatic Arteriovenous Fistula

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

CPT 35184: Repair of Congenital Arteriovenous Fistula, Extremity

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

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

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

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

Taxonomy Code	Specialty	Notes
207P00000X	Vascular Surgery	Primary specialty performing AV fistula repairs in extremities.
2080P0200X	Surgery - Vascular	Alternate vascular surgeon taxonomy used in some payor filings.
207L00000X	Interventional Cardiology	May be involved for endovascular adjuncts or access issues.
207K00000X	General Surgery	General surgeons with vascular practice may perform extremity fistula repairs.
363L00000X	Nephrology	Consulted when fistula relates to dialysis access or surveillance planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S41.01XA`	Unspecified open wound of right upper arm, initial encounter	Traumatic open injuries near an AV fistula can disrupt the fistulous connection.
`S41.11XA`	Unspecified open wound of left upper arm, initial encounter	As above for the contralateral arm.
`I77.9`	Disorder of arteries and arterioles, unspecified	General category for arterial disorders that can be associated with fistula pathology.
`I74.3`	Embolism and thrombosis of arteries of upper extremity	Thrombosis or embolic events may complicate fistula injuries necessitating repair.
`T79.8XXA`	Other early complications of trauma, initial encounter	Captures early traumatic complications around the fistula site requiring surgical intervention.
`Z98.890`	Other specified postprocedural states	Used when prior vascular access procedures or interventions relate to the current repair.
`T81.31XA`	Hemorrhage and hematoma complicating a procedure, initial encounter	Post-procedural hematoma can lead to fistula dysfunction requiring repair.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Preoperative laboratory assessment commonly performed prior to surgical repair.
`93971`	Duplex scan of extremity arteries or veins, single level and/or segmental evaluation	Used preoperatively or postoperatively to assess AV fistula flow and patency.
`35860`	Revascularization, upper extremity, open; arterial reconstruction with vein graft (eg, brachial to radial)	May be performed when arterial reconstruction is required in addition to fistula repair.
`35360`	Repair of vascular trauma, major artery or vein; with interposition graft	Related for complex traumatic vascular repairs in the extremity alongside fistula repair.
`10160`	Incision and drainage of hematoma, seroma or fluid collection	Performed if there is an associated infected or symptomatic hematoma requiring separate drainage.

OpenPayer