CPT code 36224: Carotid angiography, internal carotid, both circulations2026 Medicare rate & RVUs in Texas
Reports selective catheter angiography of one internal carotid artery when images document both the ipsilateral extracranial and intracranial circulation.
Medicare pays $2,158.43–$2,464.09 for 36224 in the office in Texas, from Beaumont, TX to Austin, TX. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 36224 covers
A physician advances a catheter selectively into an internal carotid artery and injects contrast to image that side’s extracranial and intracranial carotid circulation. Arch and cervical carotid imaging may be included when performed. Neurointerventional and diagnostic radiologists commonly perform the study in a hospital angiography suite; the service represents diagnostic imaging, not catheter placement alone.
Report the code when the record supports selective internal carotid catheterization, imaging of both circulation regions, and an interpretation of the findings. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. CMS does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 36224 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$2158.43 to $2464.09
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $2,464.09 | $328.61 |
| Beaumont, TX | $2,158.43 | $321.68 |
| Brazoria, TX | $2,318.91 | $318.66 |
| Dallas, TX | $2,334.63 | $324.29 |
| Fort Worth, TX | $2,314.67 | $324.51 |
| Galveston, TX | $2,326.22 | $321.93 |
| Houston, TX | $2,362.09 | $357.81 |
| Rest of Texas | $2,237.91 | $322.44 |
How the 36224 rate is calculated
Each of 36224’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 36224
RVUs × geographic indexes × conversion factor
Work6.09
6.09 RVUs× 1.000 GPCI
Practice expense62.32
62.32 RVUs× 1.000 GPCI
Malpractice1.96
1.96 RVUs× 1.000 GPCI
Adjusted RVUs
70.3700
Conversion factor
$33.4009
Medicare rate
$2,350.42
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 36224
The CMS indicators that decide how 36224 is paid alongside other services.
CMS payment indicators · 36224
Carotid angiography, internal carotid, both circulations
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
36224 without 50 · national office
$2,350.42
Carotid angiography, internal carotid, both circulations
36224-50 · Bilateral: 150%
$3,525.63
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
36224 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 36223Carotid angiographyIpsilateral intracranial circulation
- 36223 is based on selective placement in the common carotid or innominate artery; 36224 requires selective internal carotid placement and imaging of the ipsilateral extracranial and intracranial circulation.
- 36222Carotid angiographyCommon carotid, extracranial
- 36222 describes selective common carotid or innominate placement with extracranial carotid imaging. Choose 36224 when the catheter is selectively placed in the internal carotid and both circulation regions are imaged.
- 36226Vertebral angiographyDirect vertebral selection
- 36226 covers selective vertebral artery angiography. 36224 applies to the internal carotid artery and its ipsilateral extracranial and intracranial circulation.
- 36228Intracranial catheterizationAdditional intracranial branch
- 36228 is for selective catheterization and angiography of an additional intracranial branch; 36224 covers the internal carotid circulation study.
36224 billing questions
Does catheter placement alone support 36224?
No. The study includes angiography of the ipsilateral extracranial and intracranial carotid circulation; catheter placement without that imaging does not describe the service.
When should 36223 be considered instead?
Use 36223 when the selective catheter position is in the common carotid or innominate artery and the documented imaging meets that code’s criteria. 36224 is for selective placement in the internal carotid artery.
What documentation supports reporting 36224?
Document the side, selective internal carotid catheter position, imaging of both the ipsilateral extracranial and intracranial circulation, and the angiographic interpretation.
How is bilateral internal carotid angiography paid?
CMS identifies this as a bilateral procedure; reporting modifier 50 is paid at 150%.
Are same-day services included in the global period?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for this procedure. Co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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