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CPT code 36226: Vertebral angiography, direct vertebral selection2026 Medicare rate & RVUs in Puerto Rico

Reports direct selective catheterization of one vertebral artery with angiographic evaluation of its cervical and intracranial circulation.

CMS RVU26DEffective Oct 1, 2026One payment locality21.8K Medicare services in 2024

In Puerto Rico, Medicare pays $2,307.20 for 36226 in the office and $329.05 when it’s performed in a hospital or facility.

$2,307.20Office (non-facility)
$329.05Hospital or facility
+0.9%vs the national office rate ($2,285.96)

Check a contract rate as a % of Medicare · 36226 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 36226 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 36226 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 36226 covers

Code 36226 covers advancing a catheter directly into a vertebral artery and imaging the ipsilateral vertebral circulation in the neck and intracranially. Neurointerventional radiologists, neuroradiologists, neurosurgeons, and other physicians may perform the study in a hospital angiography suite or another appropriately equipped setting. It is used in diagnostic cerebral angiography evaluating conditions such as vertebrobasilar stenosis, arterial dissection, aneurysm, or vascular malformation. The service includes the selective catheter placement and the associated angiographic imaging of that circulation.

Report one unit for each side selectively studied, with the catheter position and imaged territory documented. A catheter left in the subclavian artery, rather than advanced directly into the vertebral artery, points to 36225 instead. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; 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.

How Puerto Rico compares for 36226

Across 109 of 109 payment localities, the office rate for 36226 runs from $1,970.26 in Arkansas to $3,170.72 in San Benito County, CA. Puerto Rico pays $2,307.20. The RVUs are the same everywhere; the geographic indexes change the dollars.

36226 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$2,307.20
  2. Los Angeles, CA · California$2,642.12+$334.92
  3. Washington, DC area · District of Columbia$2,663.47+$356.27
  4. Miami, FL · Florida$2,466.77+$159.57
  5. Chicago, IL · Illinois$2,380.52+$73.32
  6. Manhattan, NY · New York$2,663.54+$356.34
  7. Alaska · Alaska$2,490.07+$182.87

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

36226 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$2,005.82$293.78
ArkansasArkansas$1,970.26$289.52
ArizonaArizona$2,214.15$318.18
Bakersfield, CACalifornia$2,458.52$314.05
Chico, CACalifornia$2,453.43$308.97
El Centro, CACalifornia$2,453.75$309.29
Fresno, CACalifornia$2,453.43$308.97
Hanford, CACalifornia$2,453.43$308.97

36226 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$1,970.26

$2,812.08

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
36226 office rate range by state
State / territoryOffice rate rangeLocalities
AK$2,490.071
AL$2,005.821
AR$1,970.261
AZ$2,214.151
CA$2,453.43–$3,170.7229
CO$2,403.531
CT$2,458.911
DC$2,663.471
DE$2,256.281
FL$2,229.40–$2,466.773
GA$2,080.28–$2,331.752
GU$2,535.481
HI$2,535.481
IA$2,075.721
ID$2,090.691
IL$2,146.46–$2,391.394
IN$2,105.651
KS$2,060.381
KY$2,056.461
LA$2,051.15–$2,175.592
MA$2,383.17–$2,678.822
MD$2,306.95–$2,663.473
ME$2,100.24–$2,244.132
MI$2,118.63–$2,259.312
MN$2,299.341
MO$2,005.75–$2,189.203
MS$1,988.661
MT$2,285.831
NC$2,127.571
ND$2,247.861
NE$2,090.651
NH$2,360.701
NJ$2,486.01–$2,626.082
NM$2,131.321
NV$2,277.271
NY$2,165.99–$2,735.425
OH$2,110.871
OK$2,055.691
OR$2,258.84–$2,496.842
PA$2,116.92–$2,384.752
PR$2,307.201
RI$2,349.501
SC$2,122.941
SD$2,243.381
TN$2,072.591
TX$2,099.75–$2,396.128
UT$2,158.311
VA$2,232.79–$2,663.472
VI$2,307.201
VT$2,234.091
WA$2,380.25–$2,742.572
WI$2,156.811
WV$2,049.181
WY$2,269.281

See 36226 in every payment locality

How the 36226 rate is calculated

Each of 36226’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 · 36226

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.09

6.09 RVUs× 1.000 GPCI

Practice expense60.43

60.43 RVUs× 1.000 GPCI

Malpractice1.92

1.92 RVUs× 1.000 GPCI

Adjusted RVUs

68.4400

Conversion factor

$33.4009

Medicare rate

$2,285.96

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,452

Code
36226
Physician work
6.09
Practice expense
60.43
Malpractice
1.92

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 36226 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work6.09× 1.0006.0900
Practice expense60.43× 1.01161.0947
Malpractice1.92× 0.9851.8912
Total RVUs69.0759
Conversion factor× 33.4009

Office rate, Puerto Rico$2307.20

Office: (6.09 × 1 + 60.43 × 1.011 + 1.92 × 0.985) × $33.4009 = $2307.20

Facility: (6.09 × 1 + 1.85 × 1.011 + 1.92 × 0.985) × $33.4009 = $329.05

Open 36226 in the RVU calculator

Payment rules and modifiers for 36226

The CMS indicators that decide how 36226 is paid alongside other services.

CMS payment indicators · 36226

Vertebral angiography, direct vertebral selection

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

36226 without 50 · national office

$2,285.96

Vertebral angiography, direct vertebral selection

36226-50 · Bilateral: 150%

$3,428.94

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).

When to use modifier 50

Codes related to 36226

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 36226
CodeHow it relatesOffice range, Puerto Rico
Used instead
36225Subclavian angiography, unilateral selective placementUsed when the catheter remains in the subclavian artery for ipsilateral vertebral angiography.$1,808.48
36221Aortic arch angiography, nonselective thoracic aortaCovers arch-level angiography without direct selective vertebral catheterization.$961.22
Often billed with
36224Carotid angiography, internal carotid, both circulationsMay be reported in the same cerebral angiographic session for selective internal carotid imaging.$2,372.34
Add-on codes
36228Intracranial catheterization, additional intracranial branchMay be the primary vertebral study when additional intracranial branch catheterization is performed.$1,555.31

How 36226 has changed in Puerto Rico

36226 · Office / nonfacility

$2307.20

Effective 2026-10-01

The base rate is $394.54 higher than on 2025-10-01, moving from $1912.66 to $2307.20 (20.6%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $1912.66changed to$2307.20

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 6.25 changed to 6.09
    • Practice expense RVU 50.66 changed to 60.43
    • Malpractice RVU 1.90 changed to 1.92
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $1998.49changed to$1912.66

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 51.58 changed to 50.66
    • Malpractice RVU 1.88 changed to 1.90

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $1965.87changed to$1998.49

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $2032.33changed to$1965.87

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 51.54 changed to 51.58
    • Malpractice RVU 1.80 changed to 1.88
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $2019.34changed to$2032.33

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $2066.97changed to$2019.34

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 51.43 changed to 51.54
    • Malpractice RVU 1.66 changed to 1.80
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $2132.00changed to$2066.97

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 52.87 changed to 51.43
    • Malpractice RVU 1.58 changed to 1.66

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $2023.75changed to$2132.00

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 47.96 changed to 52.87
    • Malpractice RVU 1.50 changed to 1.58
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $1949.19changed to$2023.75

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 45.93 changed to 47.96
    • Malpractice RVU 1.60 changed to 1.50
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $1915.19changed to$1949.19

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 45.10 changed to 45.93
    • Malpractice RVU 1.55 changed to 1.60

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $1575.40changed to$1915.19

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 42.87 changed to 45.10
    • Malpractice RVU 1.48 changed to 1.55
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $1371.12changed to$1575.40

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 6.50 changed to 6.25
    • Practice expense RVU 44.48 changed to 42.87
    • Malpractice RVU 1.49 changed to 1.48
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $1381.88changed to$1371.12

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 44.68 changed to 44.48
    • Malpractice RVU 1.56 changed to 1.49

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $1375.00changed to$1381.88

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $1266.35changed to$1375.00

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 41.28 changed to 44.68
    • Malpractice RVU 1.05 changed to 1.56
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $1241.06changed to$1266.35

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 43.81 changed to 41.28
    • Malpractice RVU 1.10 changed to 1.05
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $1241.06

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$2,307.20$329.05RVU26D
2026-07-01$2,307.20$329.05RVU26C
2026-04-01$2,307.20$329.05RVU26B
2026-01-01$2,307.20$329.05RVU26A
2025-10-01$1,912.66$354.05RVU25D
2025-07-01$1,912.66$354.05RVU25C
2025-04-01$1,912.66$354.05RVU25B
2025-01-01$1,912.66$354.05RVU25A
2024-10-01$1,998.49$361.01RVU24D
2024-07-01$1,998.49$361.01RVU24C
2024-04-01$1,998.49$361.01RVU24B
2024-03-09$1,998.49$361.01RVU24AR
2024-01-01$1,965.87$355.12RVU24A
2023-10-01$2,032.33$364.38RVU23D
2023-07-01$2,019.34$364.63RVU23C
2023-04-01$2,019.34$364.63RVU23B
2023-01-01$2,019.34$364.63RVU23A
2022-10-01$2,066.97$365.37RVU22D
2022-07-01$2,066.97$365.37RVU22C
2022-04-01$2,066.97$365.37RVU22B
2022-01-01$2,066.97$365.37RVU22A
2021-10-01$2,132.00$364.24RVU21D
2021-07-01$2,132.00$364.24RVU21C
2021-04-01$2,132.00$364.24RVU21B
2021-01-01$2,132.00$364.24RVU21A
2020-10-01$2,023.75$371.08RVU20D
2020-07-01$2,023.75$371.08RVU20C
2020-04-01$2,023.75$371.08RVU20B
2020-01-01$2,023.75$371.08RVU20A
2019-10-01$1,949.19$372.33RVU19D
2019-07-01$1,949.19$372.33RVU19C
2019-04-01$1,949.19$372.33RVU19B
2019-01-01$1,949.19$372.33RVU19A
2018-10-01$1,915.19$370.14RVU18D
2018-07-01$1,915.19$370.14RVU18C
2018-04-01$1,915.19$370.14RVU18B
2018-01-01$1,915.19$370.14RVU18AR1
2017-10-01$1,575.40$333.67RVU17D
2017-07-01$1,575.40$333.67RVU17C
2017-04-01$1,575.40$333.67RVU17B
2017-01-01$1,575.40$333.67RVU17A
2016-10-01$1,371.12$312.22RVU16D
2016-07-01$1,371.12$312.22RVU16C
2016-04-01$1,371.12$312.22RVU16B
2016-01-01$1,371.12$312.22RVU16A
2015-10-01$1,381.88$314.59RVU15D
2015-07-01$1,381.88$314.59RVU15C
2015-04-01$1,375.00$313.03RVU15B
2015-01-01$1,375.00$313.03RVU15A
2014-10-01$1,266.35$304.52RVU14D
2014-07-01$1,266.35$304.52RVU14C
2014-04-01$1,266.35$304.52RVU14B
2014-01-01$1,266.35$304.52RVU14A
2013-10-01$1,241.06$290.21RVU13D
2013-07-01$1,241.06$290.21RVU13C
2013-04-01$1,241.06$290.21RVU13B
2013-01-01$1,241.06$290.21RVU13AR

Price 36226 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

36226 billing questions

How do I distinguish 36226 from 36225?

Use 36226 when the catheter is selectively advanced into the vertebral artery. Use 36225 when it remains in the subclavian artery for imaging of the ipsilateral vertebral circulation.

Does 36226 include the angiographic imaging?

Yes. The code encompasses selective catheter placement and angiography of the ipsilateral vertebral artery’s cervical and intracranial circulation.

How should bilateral vertebral studies be reported?

Report the bilateral service with modifier 50 when both sides are studied. CMS pays a bilateral procedure at 150%.

What documentation supports reporting 36226?

Document the side, selective catheter position within the vertebral artery, and the cervical and intracranial territory imaged.

Can 36226 be reported with carotid angiography?

It may be part of a multivessel cerebral angiographic examination when the carotid circulation is separately selectively catheterized and imaged. Document each catheter position and the circulation studied.

Can an assistant or co-surgeon be paid for this service?

CMS applies a statutory restriction to assistant-at-surgery payment for this code. 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
RVUs for 36226PPRRVU2026_Oct_nonQPP.csv, line 4,452 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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