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CPT code 36246: Selective catheterization, second-order branch2026 Medicare rate & RVUs in Puerto Rico

Reports selective catheter placement into a second-order abdominal, pelvic, or lower-extremity arterial branch during angiography or endovascular treatment.

CMS RVU26DEffective Oct 1, 2026One payment locality24.1K Medicare services in 2024

In Puerto Rico, Medicare pays $804.02 for 36246 in the office and $221.18 when it’s performed in a hospital or facility.

$804.02Office (non-facility)
$221.18Hospital or facility
+0.8%vs the national office rate ($797.95)

Check a contract rate as a % of Medicare · 36246 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 36246 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 36246 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 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.

How Puerto Rico compares for 36246

Across 109 of 109 payment localities, the office rate for 36246 runs from $696.40 in Arkansas to $1,064.64 in San Benito County, CA. Puerto Rico pays $804.02. The RVUs are the same everywhere; the geographic indexes change the dollars.

36246 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$804.02
  2. Los Angeles, CA · California$902.58+$98.56
  3. Washington, DC area · District of Columbia$917.45+$113.43
  4. Miami, FL · Florida$876.15+$72.13
  5. Chicago, IL · Illinois$847.51+$43.49
  6. Manhattan, NY · New York$926.08+$122.06
  7. Alaska · Alaska$902.84+$98.82

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

Every other payment area

36246 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$707.78$203.35
ArkansasArkansas$696.40$201.19
ArizonaArizona$774.31$215.68
Bakersfield, CACalifornia$844.89$213.05
Chico, CACalifornia$842.01$210.16
El Centro, CACalifornia$842.18$210.34
Fresno, CACalifornia$842.01$210.16
Hanford, CACalifornia$842.01$210.16

36246 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.

$696.40

$953.33

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

View every state and territory as a table
36246 office rate range by state
State / territoryOffice rate rangeLocalities
AK$902.841
AL$707.781
AR$696.401
AZ$774.311
CA$842.01–$1,064.6429
CO$830.601
CT$854.741
DC$917.451
DE$788.031
FL$789.21–$876.153
GA$739.93–$815.082
GU$865.321
HI$865.321
IA$725.841
ID$731.501
IL$765.53–$847.514
IN$736.151
KS$723.001
KY$728.421
LA$727.53–$767.342
MA$825.22–$917.102
MD$803.90–$917.453
ME$736.73–$779.612
MI$750.31–$801.022
MN$790.641
MO$714.30–$769.243
MS$705.461
MT$797.881
NC$745.121
ND$777.121
NE$729.971
NH$818.151
NJ$863.04–$906.552
NM$755.231
NV$792.691
NY$757.55–$951.775
OH$746.071
OK$725.981
OR$785.13–$858.132
PA$746.86–$832.242
PR$804.021
RI$817.051
SC$747.121
SD$774.661
TN$727.151
TX$741.50–$829.058
UT$758.401
VA$777.44–$917.452
VI$804.021
VT$774.631
WA$823.46–$935.792
WI$748.501
WV$734.521
WY$788.831

See 36246 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,456

Code
36246
Physician work
4.89
Practice expense
17.95
Malpractice
1.05

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 36246 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work4.89× 1.0004.8900
Practice expense17.95× 1.01118.1474
Malpractice1.05× 0.9851.0343
Total RVUs24.0717
Conversion factor× 33.4009

Office rate, Puerto Rico$804.02

Office: (4.89 × 1 + 17.95 × 1.011 + 1.05 × 0.985) × $33.4009 = $804.02

Facility: (4.89 × 1 + 0.69 × 1.011 + 1.05 × 0.985) × $33.4009 = $221.18

Open 36246 in the RVU calculator

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

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

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).

When to use modifier 50

Codes related to 36246

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

Codes related to 36246
CodeHow it relatesOffice range, Puerto Rico
Same family
36245Selective catheterization, first-order abdominal or leg branchReports first-order placement in an abdominal, pelvic, or lower-extremity arterial family.$1,209.53
36247Selective catheterization, third order or beyondReports third-order placement in the same arterial regions.$1,367.97
Add-on codes
36248Selective catheterization, additional abdominal or limb branchAdd-on code for additional qualifying branch selections in the vascular family.$113.00
Used instead
36200Aortic catheterization, nonselective placementDescribes aortic catheter placement rather than selective second-order branch placement.$571.18

How 36246 has changed in Puerto Rico

36246 · Office / nonfacility

$804.02

Effective 2026-10-01

The base rate is $31.07 higher than on 2025-10-01, moving from $772.95 to $804.02 (4.0%).

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

    $772.95changed to$804.02

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 5.02 changed to 4.89
    • Practice expense RVU 17.75 changed to 17.95
    • Malpractice RVU 1.02 changed to 1.05
    • 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

    $821.90changed to$772.95

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 18.52 changed to 17.75
    • Malpractice RVU 1.04 changed to 1.02

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $808.48changed to$821.90

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $853.51changed to$808.48

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 19.05 changed to 18.52
    • Malpractice RVU 0.98 changed to 1.04
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $848.87changed to$853.51

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

  6. January 1, 2023

    RVU23A

    $897.13changed to$848.87

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 19.75 changed to 19.05
    • Malpractice RVU 1.01 changed to 0.98
    • 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

    $916.89changed to$897.13

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 20.12 changed to 19.75
    • Malpractice RVU 0.99 changed to 1.01

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $890.95changed to$916.89

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 18.57 changed to 20.12
    • Malpractice RVU 0.96 changed to 0.99
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $861.87changed to$890.95

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 17.81 changed to 18.57
    • Malpractice RVU 0.97 changed to 0.96
    • 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

    $843.53changed to$861.87

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 17.34 changed to 17.81
    • Malpractice RVU 0.96 changed to 0.97

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $735.52changed to$843.53

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 17.35 changed to 17.34
    • Malpractice RVU 0.97 changed to 0.96
    • 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

    $682.27changed to$735.52

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 5.27 changed to 5.02
    • Practice expense RVU 19.13 changed to 17.35
    • Malpractice RVU 1.02 changed to 0.97
    • 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

    $684.44changed to$682.27

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 19.11 changed to 19.13
    • Malpractice RVU 1.04 changed to 1.02

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $681.03changed to$684.44

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $671.39changed to$681.03

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 19.10 changed to 19.11
    • Malpractice RVU 0.94 changed to 1.04
    • 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

    $677.10changed to$671.39

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 21.22 changed to 19.10
    • Malpractice RVU 0.98 changed to 0.94
    • 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: $677.10

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$804.02$221.18RVU26D
2026-07-01$804.02$221.18RVU26C
2026-04-01$804.02$221.18RVU26B
2026-01-01$804.02$221.18RVU26A
2025-10-01$772.95$238.43RVU25D
2025-07-01$772.95$238.43RVU25C
2025-04-01$772.95$238.43RVU25B
2025-01-01$772.95$238.43RVU25A
2024-10-01$821.90$245.35RVU24D
2024-07-01$821.90$245.35RVU24C
2024-04-01$821.90$245.35RVU24B
2024-03-09$821.90$245.35RVU24AR
2024-01-01$808.48$241.34RVU24A
2023-10-01$853.51$248.22RVU23D
2023-07-01$848.87$248.39RVU23C
2023-04-01$848.87$248.39RVU23B
2023-01-01$848.87$248.39RVU23A
2022-10-01$897.13$254.93RVU22D
2022-07-01$897.13$254.93RVU22C
2022-04-01$897.13$254.93RVU22B
2022-01-01$897.13$254.93RVU22A
2021-10-01$916.89$256.71RVU21D
2021-07-01$916.89$256.71RVU21C
2021-04-01$916.89$256.71RVU21B
2021-01-01$916.89$256.71RVU21A
2020-10-01$890.95$265.24RVU20D
2020-07-01$890.95$265.24RVU20C
2020-04-01$890.95$265.24RVU20B
2020-01-01$890.95$265.24RVU20A
2019-10-01$861.87$266.33RVU19D
2019-07-01$861.87$266.33RVU19C
2019-04-01$861.87$266.33RVU19B
2019-01-01$861.87$266.33RVU19A
2018-10-01$843.53$266.77RVU18D
2018-07-01$843.53$266.77RVU18C
2018-04-01$843.53$266.77RVU18B
2018-01-01$843.53$266.77RVU18AR1
2017-10-01$735.52$247.67RVU17D
2017-07-01$735.52$247.67RVU17C
2017-04-01$735.52$247.67RVU17B
2017-01-01$735.52$247.67RVU17A
2016-10-01$682.27$239.02RVU16D
2016-07-01$682.27$239.02RVU16C
2016-04-01$682.27$239.02RVU16B
2016-01-01$682.27$239.02RVU16A
2015-10-01$684.44$240.09RVU15D
2015-07-01$684.44$240.09RVU15C
2015-04-01$681.03$238.90RVU15B
2015-01-01$681.03$238.90RVU15A
2014-10-01$671.39$237.82RVU14D
2014-07-01$671.39$237.82RVU14C
2014-04-01$671.39$237.82RVU14B
2014-01-01$671.39$237.82RVU14A
2013-10-01$677.10$227.51RVU13D
2013-07-01$677.10$227.51RVU13C
2013-04-01$677.10$227.51RVU13B
2013-01-01$677.10$227.51RVU13AR

Price 36246 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

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

Show the CMS file lines behind this rate
RVUs for 36246PPRRVU2026_Oct_nonQPP.csv, line 4,456 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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