CPT 35226
Global 090 ActiveRepair blood vessel dir lxtr
CPT 35226 Billing & Documentation Guide
CPT code 35226 (Repair blood vessel dir lxtr) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 14.92, a non-facility practice expense RVU of 3.98, and a malpractice RVU of 3.75, a total non-facility RVU of 22.65 and facility RVU of 22.65. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $754.47, though rates vary from $664.27 to $958.1 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 35226, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 35226 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 3 units of 35226 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 35226
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 14.92 | 14.92 |
| Practice Expense RVU | 3.98 | 3.98 |
| Malpractice RVU | 3.75 | 3.75 |
| Total RVU | 22.65 | 22.65 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 35226
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $741.43 | $741.43 | $719.65 - $811.99 | 29 |
| Florida | $875.54 | $875.54 | $813.68 - $953.49 | 3 |
| Georgia | $775.78 | $775.78 | $766.22 - $785.33 | 2 |
| Illinois | $867.89 | $867.89 | $815.48 - $922.89 | 4 |
| Michigan | $799.46 | $799.46 | $761.12 - $837.8 | 2 |
| North Carolina | $702.41 | $702.41 | $702.41 - $702.41 | 1 |
| New York | $840.56 | $840.56 | $712.68 - $920.89 | 5 |
| Ohio | $745.97 | $745.97 | $745.97 - $745.97 | 1 |
| Pennsylvania | $766.93 | $766.93 | $738.74 - $795.12 | 2 |
| Texas | $748.3 | $748.3 | $731.76 - $806.68 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 35226
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 35226 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0254T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0543T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0544T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 35226
What does CPT code 35226 mean? +
CPT code 35226 represents: Repair blood vessel dir lxtr. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 090.
What is the Medicare reimbursement for CPT 35226? +
The 2026 Medicare national average non-facility payment for CPT 35226 is $754.47. Rates range from $664.27 to $958.1 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 35226? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 35226? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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