FeeBase
Log inGet started
Menu

CPT code 36227: External carotid angiography, selective placement, unilateral2026 Medicare rate & RVUs in Puerto Rico

Reports selective catheter placement in an external carotid artery with angiography of its circulation, including intracranial imaging when performed.

CMS RVU26DEffective Oct 1, 2026One payment locality13.7K Medicare services in 2024

In Puerto Rico, Medicare pays $275.25 for 36227 in the office and $108.10 when it’s performed in a hospital or facility.

$275.25Office (non-facility)
$108.10Hospital or facility
+0.6%vs the national office rate ($273.55)

Check a contract rate as a % of Medicare · 36227 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 36227 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 36227 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 36227 covers

A physician, commonly an interventional radiologist or neurointerventional specialist, advances a catheter selectively into an external carotid artery and performs angiography of that artery’s circulation. The study may help evaluate head and neck vascular findings, such as a suspected vascular lesion or bleeding source, and may be performed during a diagnostic or interventional angiography session. Intracranial imaging is included when performed as part of this external carotid study.

Report 36227 as an add-on with an appropriate primary cervicocerebral angiography procedure, not by itself. Documentation should identify the catheterized external carotid artery, the angiographic work performed, and the clinical findings supporting the study. CMS treats payment for this add-on as within the primary procedure’s global period. For a bilateral procedure reported with modifier 50, CMS pays 150%.

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 36227

Across 109 of 109 payment localities, the office rate for 36227 runs from $237.12 in Arkansas to $352.17 in San Benito County, CA. Puerto Rico pays $275.25. The RVUs are the same everywhere; the geographic indexes change the dollars.

36227 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$275.25
  2. Los Angeles, CA · California$302.67+$27.42
  3. Washington, DC area · District of Columbia$312.39+$37.14
  4. Miami, FL · Florida$314.28+$39.03
  5. Chicago, IL · Illinois$303.06+$27.81
  6. Manhattan, NY · New York$320.40+$45.15
  7. Alaska · Alaska$309.82+$34.57

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

Every other payment area

36227 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$241.17$96.50
ArkansasArkansas$237.12$95.10
ArizonaArizona$264.73$104.52
Bakersfield, CACalifornia$283.99$102.79
Chico, CACalifornia$282.27$101.07
El Centro, CACalifornia$282.38$101.18
Fresno, CACalifornia$282.27$101.07
Hanford, CACalifornia$282.27$101.07

36227 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.

$237.12

$317.22

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

View every state and territory as a table
36227 office rate range by state
State / territoryOffice rate rangeLocalities
AK$309.821
AL$241.171
AR$237.121
AZ$264.731
CA$282.27–$352.1729
CO$281.371
CT$293.621
DC$312.391
DE$269.501
FL$276.39–$314.283
GA$257.88–$281.062
GU$289.581
HI$289.581
IA$244.851
ID$247.421
IL$269.79–$303.064
IN$248.981
KS$245.151
KY$251.321
LA$251.52–$265.672
MA$279.97–$309.602
MD$274.66–$312.393
ME$250.65–$263.892
MI$260.37–$282.022
MN$263.601
MO$247.64–$264.783
MS$242.351
MT$273.511
NC$253.411
ND$260.661
NE$245.901
NH$278.371
NJ$295.29–$308.722
NM$262.671
NV$270.111
NY$257.92–$331.245
OH$257.741
OK$249.061
OR$266.37–$289.482
PA$257.30–$286.502
PR$275.251
RI$278.571
SC$256.341
SD$259.141
TN$246.781
TX$255.48–$281.878
UT$260.321
VA$264.05–$312.392
VI$275.251
VT$260.991
WA$278.99–$314.692
WI$250.811
WV$258.851
WY$267.911

See 36227 in every payment locality

How the 36227 rate is calculated

Each of 36227’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 · 36227

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.04

2.04 RVUs× 1.000 GPCI

Practice expense5.50

5.50 RVUs× 1.000 GPCI

Malpractice0.65

0.65 RVUs× 1.000 GPCI

Adjusted RVUs

8.1900

Conversion factor

$33.4009

Medicare rate

$273.55

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

4,453

Code
36227
Physician work
2.04
Practice expense
5.50
Malpractice
0.65

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 36227 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.04× 1.0002.0400
Practice expense5.50× 1.0115.5605
Malpractice0.65× 0.9850.6402
Total RVUs8.2407
Conversion factor× 33.4009

Office rate, Puerto Rico$275.25

Office: (2.04 × 1 + 5.5 × 1.011 + 0.65 × 0.985) × $33.4009 = $275.25

Facility: (2.04 × 1 + 0.55 × 1.011 + 0.65 × 0.985) × $33.4009 = $108.10

Open 36227 in the RVU calculator

Payment rules and modifiers for 36227

The CMS indicators that decide how 36227 is paid alongside other services.

CMS payment indicators · 36227

External carotid angiography, selective placement, unilateral

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
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

36227 without 50 · national office

$273.55

External carotid angiography, selective placement, unilateral

36227-50 · Bilateral: 150%

$410.33

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 36227

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

Codes related to 36227
CodeHow it relatesOffice range, Puerto Rico
Primary code
36221Aortic arch angiography, nonselective thoracic aortaA primary aortic arch angiography service that may accompany this add-on.$961.22
36222Carotid angiography, common carotid, extracranialA primary carotid or innominate angiography service that may accompany this add-on.$1,270.37
36224Carotid angiography, internal carotid, both circulationsA primary internal carotid angiography service that may accompany this add-on.$2,372.34
36226Vertebral angiography, direct vertebral selectionA primary vertebral artery angiography service that may accompany this add-on.$2,307.20
Used instead
36228Intracranial catheterization, additional intracranial branchTargets an intracranial artery branch rather than the external carotid circulation.$1,555.31

How 36227 has changed in Puerto Rico

36227 · Office / nonfacility

$275.25

Effective 2026-10-01

The base rate is $39.10 higher than on 2025-10-01, moving from $236.15 to $275.25 (16.6%).

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

    $236.15changed to$275.25

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.09 changed to 2.04
    • Practice expense RVU 4.56 changed to 5.50
    • Malpractice RVU 0.63 changed to 0.65
    • 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

    $243.02changed to$236.15

    • Conversion factor 33.2875 changed to 32.3465

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $239.05changed to$243.02

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $244.89changed to$239.05

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.52 changed to 4.56
    • Malpractice RVU 0.59 changed to 0.63
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $243.99changed to$244.89

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

  6. January 1, 2023

    RVU23A

    $244.92changed to$243.99

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.40 changed to 4.52
    • Malpractice RVU 0.56 changed to 0.59
    • 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

    $254.72changed to$244.92

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.66 changed to 4.40
    • Malpractice RVU 0.52 changed to 0.56

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $257.68changed to$254.72

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.51 changed to 4.66
    • Malpractice RVU 0.51 changed to 0.52
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $261.53changed to$257.68

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.61 changed to 4.51
    • Malpractice RVU 0.53 changed to 0.51
    • 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

    $264.16changed to$261.53

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.71 changed to 4.61
    • Malpractice RVU 0.51 changed to 0.53

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $228.15changed to$264.16

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.61 changed to 4.71
    • Malpractice RVU 0.50 changed to 0.51
    • 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

    $196.78changed to$228.15

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.64 changed to 4.61
    • Malpractice RVU 0.46 changed to 0.50
    • 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

    $203.84changed to$196.78

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.87 changed to 4.64
    • Malpractice RVU 0.51 changed to 0.46

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $202.83changed to$203.84

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $193.00changed to$202.83

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.64 changed to 4.87
    • Malpractice RVU 0.32 changed to 0.51
    • 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

    $188.78changed to$193.00

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.98 changed to 4.64
    • Malpractice RVU 0.33 changed to 0.32
    • 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: $188.78

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$275.25$108.10RVU26D
2026-07-01$275.25$108.10RVU26C
2026-04-01$275.25$108.10RVU26B
2026-01-01$275.25$108.10RVU26A
2025-10-01$236.15$116.61RVU25D
2025-07-01$236.15$116.61RVU25C
2025-04-01$236.15$116.61RVU25B
2025-01-01$236.15$116.61RVU25A
2024-10-01$243.02$118.99RVU24D
2024-07-01$243.02$118.99RVU24C
2024-04-01$243.02$118.99RVU24B
2024-03-09$243.02$118.99RVU24AR
2024-01-01$239.05$117.05RVU24A
2023-10-01$244.89$119.87RVU23D
2023-07-01$243.99$119.96RVU23C
2023-04-01$243.99$119.96RVU23B
2023-01-01$243.99$119.96RVU23A
2022-10-01$244.92$120.74RVU22D
2022-07-01$244.92$120.74RVU22C
2022-04-01$244.92$120.74RVU22B
2022-01-01$244.92$120.74RVU22A
2021-10-01$254.72$120.01RVU21D
2021-07-01$254.72$120.01RVU21C
2021-04-01$254.72$120.01RVU21B
2021-01-01$254.72$120.01RVU21A
2020-10-01$257.68$123.08RVU20D
2020-07-01$257.68$123.08RVU20C
2020-04-01$257.68$123.08RVU20B
2020-01-01$257.68$123.08RVU20A
2019-10-01$261.53$122.90RVU19D
2019-07-01$261.53$122.90RVU19C
2019-04-01$261.53$122.90RVU19B
2019-01-01$261.53$122.90RVU19A
2018-10-01$264.16$121.69RVU18D
2018-07-01$264.16$121.69RVU18C
2018-04-01$264.16$121.69RVU18B
2018-01-01$264.16$121.69RVU18AR1
2017-10-01$228.15$110.80RVU17D
2017-07-01$228.15$110.80RVU17C
2017-04-01$228.15$110.80RVU17B
2017-01-01$228.15$110.80RVU17A
2016-10-01$196.78$99.09RVU16D
2016-07-01$196.78$99.09RVU16C
2016-04-01$196.78$99.09RVU16B
2016-01-01$196.78$99.09RVU16A
2015-10-01$203.84$100.48RVU15D
2015-07-01$203.84$100.48RVU15C
2015-04-01$202.83$99.98RVU15B
2015-01-01$202.83$99.98RVU15A
2014-10-01$193.00$97.06RVU14D
2014-07-01$193.00$97.06RVU14C
2014-04-01$193.00$97.06RVU14B
2014-01-01$193.00$97.06RVU14A
2013-10-01$188.78$92.36RVU13D
2013-07-01$188.78$92.36RVU13C
2013-04-01$188.78$92.36RVU13B
2013-01-01$188.78$92.36RVU13AR

Price 36227 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

36227 billing questions

Can 36227 be reported by itself?

No. It is an add-on code and must be reported with an eligible primary cervicocerebral angiography procedure.

How is 36227 different from 36224?

36227 describes selective catheter placement and angiography of the external carotid circulation. 36224 concerns selective placement in the internal carotid artery and angiography of its circulation.

Does 36227 include the angiographic imaging?

Yes. Angiography of the external carotid circulation is part of the service, including intracranial imaging when performed.

How should bilateral external carotid studies be reported?

For a bilateral procedure, use modifier 50 as applicable. CMS pays 150% for the bilateral procedure.

What documentation supports reporting 36227?

Document the external carotid artery selectively catheterized, the angiography performed, and the clinical reason and findings for the study.

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 36227PPRRVU2026_Oct_nonQPP.csv, line 4,453 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 36227 pays in Puerto Rico?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 36227 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist