CPT 35256
Global 090 ActiveRepair blvsl vn grf lxtr
CPT 35256 Billing & Documentation Guide
CPT code 35256 (Repair blvsl vn grf 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 18.58, a non-facility practice expense RVU of 4.67, and a malpractice RVU of 4.52, a total non-facility RVU of 27.77 and facility RVU of 27.77. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $925.28, though rates vary from $816.52 to $1180.19 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 35256, 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 35256 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 2 units of 35256 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 35256
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 18.58 | 18.58 |
| Practice Expense RVU | 4.67 | 4.67 |
| Malpractice RVU | 4.52 | 4.52 |
| Total RVU | 27.77 | 27.77 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 35256
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 | $909.27 | $909.27 | $883.02 - $994.7 | 29 |
| Florida | $1070.98 | $1070.98 | $996.62 - $1164.77 | 3 |
| Georgia | $950.96 | $950.96 | $939.68 - $962.25 | 2 |
| Illinois | $1061.99 | $1061.99 | $998.97 - $1128.18 | 4 |
| Michigan | $979.55 | $979.55 | $933.45 - $1025.65 | 2 |
| North Carolina | $862.59 | $862.59 | $862.59 - $862.59 | 1 |
| New York | $1029.28 | $1029.28 | $874.91 - $1126.12 | 5 |
| Ohio | $915.18 | $915.18 | $915.18 - $915.18 | 1 |
| Pennsylvania | $940.35 | $940.35 | $906.45 - $974.25 | 2 |
| Texas | $917.8 | $917.8 | $897.89 - $988.18 | 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 35256
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 35256 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 |
| 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 |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 35256
What does CPT code 35256 mean? +
CPT code 35256 represents: Repair blvsl vn grf lxtr. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 090.
What is the Medicare reimbursement for CPT 35256? +
The 2026 Medicare national average non-facility payment for CPT 35256 is $925.28. Rates range from $816.52 to $1180.19 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 35256? +
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 35256? +
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 June 2, 2026.
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