CPT code 36246: Selective catheterization, second-order branch2026 Medicare rate & RVUs in Missouri
Reports selective catheter placement into a second-order abdominal, pelvic, or lower-extremity arterial branch during angiography or endovascular treatment.
Medicare pays $714.30–$769.24 for 36246 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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 36246 covers
This service covers advancing a catheter selectively into a second-order branch of the abdominal, pelvic, or lower-extremity arterial system. Interventional radiologists, vascular surgeons, and other physicians performing vascular procedures may use it to reach a target branch for diagnostic angiography or endovascular treatment in an angiography suite, catheterization laboratory, or operating room.
Choose the code according to the most selective branch reached in the vascular family: 36246 represents a second-order selection, while a third-order selection in that family is reported at the higher level. Document the access route, vascular family, target branch, and catheter position; catheter exchanges or imaging runs alone do not establish another selective placement. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures occur in one session, Medicare pays the highest-valued procedure in full and other procedures at 50%. Modifier 50 for a bilateral procedure is paid at 150%. Medicare does not pay an assistant at surgery for this code; 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 36246 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$714.30 to $769.24
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $760.57 | $219.24 |
| Metropolitan St. Louis, MO | $769.24 | $220.41 |
| Rest of Missouri | $714.30 | $217.36 |
How the 36246 rate is calculated
Each of 36246’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 · 36246
RVUs × geographic indexes × conversion factor
Work4.89
4.89 RVUs× 1.000 GPCI
Practice expense17.95
17.95 RVUs× 1.000 GPCI
Malpractice1.05
1.05 RVUs× 1.000 GPCI
Adjusted RVUs
23.8900
Conversion factor
$33.4009
Medicare rate
$797.95
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 36246
The CMS indicators that decide how 36246 is paid alongside other services.
CMS payment indicators · 36246
Selective catheterization, second-order branch
| 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
36246 without 50 · national office
$797.95
Selective catheterization, second-order branch
36246-50 · Bilateral: 150%
$1,196.93
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).
36246 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 36245Selective catheterizationFirst-order abdominal or leg branch
- Use 36245 when the selected abdominal, pelvic, or lower-extremity branch is first order. Use 36246 when the catheter reaches a second-order branch.
- 36247Selective catheterizationThird order or beyond
- Use 36247 when the catheter is advanced to a third-order branch in the vascular family; 36246 represents second-order selection.
- 36248Selective catheterizationAdditional abdominal or limb branch
- 36248 is an add-on for additional qualifying branch selections, not the initial second-order placement represented by 36246.
- 36200Aortic catheterizationNonselective placement
- 36200 describes placement in the aorta. It does not represent selective catheter positioning in a second-order abdominal, pelvic, or lower-extremity branch.
36246 billing questions
How does 36246 differ from 36245 and 36247?
Select 36246 when the catheter reaches a second-order branch in the abdominal, pelvic, or lower-extremity arterial system. Use 36245 for first-order placement and 36247 for third-order placement in the vascular family.
Can angiography or treatment be reported separately?
36246 describes selective catheter placement, not the imaging or treatment itself. Report other services only when they were performed, documented, and separately reportable under their code instructions.
When is 36248 reported with 36246?
36248 is an add-on for an additional qualifying second-order, third-order, or more distal branch selection in the same vascular family. The record should show the additional branch catheterized.
Are units based on catheter exchanges or angiographic runs?
No. Select the code based on the order of the branch reached and the vascular family; a catheter exchange or another imaging run alone is not an additional selective placement.
How is bilateral reporting handled?
For a bilateral procedure, modifier 50 is paid at 150%. The documentation should support selective catheterization on both sides.
Does the code have a postoperative global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
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
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