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CPT code 36254: Renal catheterization, second-order or more, bilateral2026 Medicare rate & RVUs in Puerto Rico

Reports selective catheter placement in second-order or more distal renal artery branches on both sides, with diagnostic renal angiographic imaging.

CMS RVU26DEffective Oct 1, 2026One payment locality138 Medicare services in 2024

In Puerto Rico, Medicare pays $1,926.54 for 36254 in the office and $362.05 when it’s performed in a hospital or facility.

$1,926.54Office (non-facility)
$362.05Hospital or facility
+0.9%vs the national office rate ($1,909.86)

Check a contract rate as a % of Medicare · 36254 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 36254 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 36254 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 36254 covers

This service covers selective catheter placement into second-order or more distal branches of the renal arteries on both sides, together with diagnostic renal angiographic imaging. It is typically performed by an interventional radiologist, vascular surgeon, or other physician evaluating suspected renovascular disease, such as renal artery stenosis. The catheterization must reach the more selective branch level bilaterally; imaging only the main renal arteries does not establish this code’s level of service.

Choose the code based on the documented catheter positions and the sides examined. The report should identify the right and left renal branches selected and describe the angiographic study. The code is priced as bilateral, so modifier 50 does not increase payment. It has a 0-day global period, with same-day preoperative and postoperative care included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple procedure reduction. 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 36254

Across 109 of 109 payment localities, the office rate for 36254 runs from $1,656.96 in Arkansas to $2,616.29 in San Benito County, CA. Puerto Rico pays $1,926.54. The RVUs are the same everywhere; the geographic indexes change the dollars.

36254 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$1,926.54
  2. Los Angeles, CA · California$2,192.86+$266.32
  3. Washington, DC area · District of Columbia$2,214.17+$287.63
  4. Miami, FL · Florida$2,063.61+$137.07
  5. Chicago, IL · Illinois$1,994.47+$67.93
  6. Manhattan, NY · New York$2,218.56+$292.02
  7. Alaska · Alaska$2,116.18+$189.64

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

Every other payment area

36254 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$1,685.42$331.39
ArkansasArkansas$1,656.96$327.69
ArizonaArizona$1,852.10$352.61
Bakersfield, CACalifornia$2,045.27$349.25
Chico, CACalifornia$2,040.53$344.51
El Centro, CACalifornia$2,040.82$344.80
Fresno, CACalifornia$2,040.53$344.51
Hanford, CACalifornia$2,040.53$344.51

36254 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.

$1,656.96

$2,328.41

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

View every state and territory as a table
36254 office rate range by state
State / territoryOffice rate rangeLocalities
AK$2,116.181
AL$1,685.421
AR$1,656.961
AZ$1,852.101
CA$2,040.53–$2,616.2929
CO$2,002.371
CT$2,049.951
DC$2,214.171
DE$1,886.171
FL$1,868.75–$2,063.613
GA$1,748.71–$1,947.772
GU$2,104.041
HI$2,104.041
IA$1,739.451
ID$1,751.821
IL$1,803.64–$1,999.334
IN$1,763.741
KS$1,728.091
KY$1,727.921
LA$1,724.02–$1,823.622
MA$1,986.78–$2,223.462
MD$1,926.84–$2,214.173
ME$1,760.43–$1,874.192
MI$1,778.56–$1,893.682
MN$1,915.441
MO$1,688.27–$1,833.423
MS$1,673.091
MT$1,909.751
NC$1,782.151
ND$1,875.541
NE$1,751.121
NH$1,968.031
NJ$2,072.49–$2,185.182
NM$1,789.101
NV$1,901.811
NY$1,812.96–$2,277.285
OH$1,771.571
OK$1,726.321
OR$1,886.32–$2,076.222
PA$1,775.90–$1,991.042
PR$1,926.541
RI$1,961.141
SC$1,779.981
SD$1,871.501
TN$1,737.971
TX$1,762.22–$1,996.298
UT$1,808.281
VA$1,865.76–$2,214.172
VI$1,926.541
VT$1,865.371
WA$1,983.93–$2,274.192
WI$1,802.891
WV$1,725.841
WY$1,894.841

See 36254 in every payment locality

How the 36254 rate is calculated

Each of 36254’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 · 36254

RVUs × geographic indexes × conversion factor

Office or facility?

Work7.70

7.70 RVUs× 1.000 GPCI

Practice expense47.75

47.75 RVUs× 1.000 GPCI

Malpractice1.73

1.73 RVUs× 1.000 GPCI

Adjusted RVUs

57.1800

Conversion factor

$33.4009

Medicare rate

$1,909.86

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

4,462

Code
36254
Physician work
7.70
Practice expense
47.75
Malpractice
1.73

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 36254 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work7.70× 1.0007.7000
Practice expense47.75× 1.01148.2752
Malpractice1.73× 0.9851.7041
Total RVUs57.6793
Conversion factor× 33.4009

Office rate, Puerto Rico$1926.54

Office: (7.7 × 1 + 47.75 × 1.011 + 1.73 × 0.985) × $33.4009 = $1926.54

Facility: (7.7 × 1 + 1.42 × 1.011 + 1.73 × 0.985) × $33.4009 = $362.05

Open 36254 in the RVU calculator

Payment rules and modifiers for 36254

The CMS indicators that decide how 36254 is paid alongside other services.

CMS payment indicators · 36254

Renal catheterization, second-order or more, bilateral

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)2Already bilateral by definition: paid once at 100%.
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 51 · payment effect

With and without the modifier

36254 without 51 · national office

$1,909.86

Renal catheterization, second-order or more, bilateral

36254-51 · Second procedure: 50%

$954.93

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 36254

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

Codes related to 36254
CodeHow it relatesOffice range, Puerto Rico
Same family
36251Renal angiography, unilateral, main arteryUnilateral renal artery catheterization at the main-artery level.$1,236.98
36252Renal angiography, bilateral, first-order arteriesBilateral renal artery catheterization at the main-artery level.$1,354.46
36253Renal angiography, second-order or higher, unilateralUnilateral second-order-or-more selective renal branch catheterization.$1,915.00

How 36254 has changed in Puerto Rico

36254 · Office / nonfacility

$1926.54

Effective 2026-10-01

The base rate is $113.13 higher than on 2025-10-01, moving from $1813.41 to $1926.54 (6.2%).

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

    $1813.41changed to$1926.54

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 7.90 changed to 7.70
    • Practice expense RVU 46.15 changed to 47.75
    • Malpractice RVU 1.72 changed to 1.73
    • 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

    $1946.62changed to$1813.41

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 48.55 changed to 46.15

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $1914.84changed to$1946.62

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $2031.67changed to$1914.84

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 50.03 changed to 48.55
    • Malpractice RVU 1.65 changed to 1.72
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $2019.00changed to$2031.67

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

  6. January 1, 2023

    RVU23A

    $2146.78changed to$2019.00

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 52.13 changed to 50.03
    • Malpractice RVU 1.61 changed to 1.65
    • 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

    $2250.41changed to$2146.78

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 54.59 changed to 52.13
    • Malpractice RVU 1.59 changed to 1.61

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $2238.57changed to$2250.41

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 52.15 changed to 54.59
    • Malpractice RVU 1.58 changed to 1.59
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $2204.23changed to$2238.57

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 51.25 changed to 52.15
    • Malpractice RVU 1.67 changed to 1.58
    • 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

    $2217.74changed to$2204.23

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 51.65 changed to 51.25
    • Malpractice RVU 1.71 changed to 1.67

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $1890.98changed to$2217.74

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 51.02 changed to 51.65
    • Malpractice RVU 1.74 changed to 1.71
    • 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

    $1645.13changed to$1890.98

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 8.15 changed to 7.90
    • Practice expense RVU 52.87 changed to 51.02
    • Malpractice RVU 1.79 changed to 1.74
    • 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

    $1649.69changed to$1645.13

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 52.82 changed to 52.87
    • Malpractice RVU 1.78 changed to 1.79

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $1641.49changed to$1649.69

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $1598.30changed to$1641.49

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 52.13 changed to 52.82
    • Malpractice RVU 1.45 changed to 1.78
    • 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

    $1699.83changed to$1598.30

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 61.11 changed to 52.13
    • Malpractice RVU 1.52 changed to 1.45
    • 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: $1699.83

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$1,926.54$362.05RVU26D
2026-07-01$1,926.54$362.05RVU26C
2026-04-01$1,926.54$362.05RVU26B
2026-01-01$1,926.54$362.05RVU26A
2025-10-01$1,813.41$394.86RVU25D
2025-07-01$1,813.41$394.86RVU25C
2025-04-01$1,813.41$394.86RVU25B
2025-01-01$1,813.41$394.86RVU25A
2024-10-01$1,946.62$404.34RVU24D
2024-07-01$1,946.62$404.34RVU24C
2024-04-01$1,946.62$404.34RVU24B
2024-03-09$1,946.62$404.34RVU24AR
2024-01-01$1,914.84$397.74RVU24A
2023-10-01$2,031.67$409.83RVU23D
2023-07-01$2,019.00$410.04RVU23C
2023-04-01$2,019.00$410.04RVU23B
2023-01-01$2,019.00$410.04RVU23A
2022-10-01$2,146.78$415.53RVU22D
2022-07-01$2,146.78$415.53RVU22C
2022-04-01$2,146.78$415.53RVU22B
2022-01-01$2,146.78$415.53RVU22A
2021-10-01$2,250.41$417.23RVU21D
2021-07-01$2,250.41$417.23RVU21C
2021-04-01$2,250.41$417.23RVU21B
2021-01-01$2,250.41$417.23RVU21A
2020-10-01$2,238.57$433.85RVU20D
2020-07-01$2,238.57$433.85RVU20C
2020-04-01$2,238.57$433.85RVU20B
2020-01-01$2,238.57$433.85RVU20A
2019-10-01$2,204.23$437.20RVU19D
2019-07-01$2,204.23$437.20RVU19C
2019-04-01$2,204.23$437.20RVU19B
2019-01-01$2,204.23$437.20RVU19A
2018-10-01$2,217.74$441.77RVU18D
2018-07-01$2,217.74$441.77RVU18C
2018-04-01$2,217.74$441.77RVU18B
2018-01-01$2,217.74$441.77RVU18AR1
2017-10-01$1,890.98$405.94RVU17D
2017-07-01$1,890.98$405.94RVU17C
2017-04-01$1,890.98$405.94RVU17B
2017-01-01$1,890.98$405.94RVU17A
2016-10-01$1,645.13$380.76RVU16D
2016-07-01$1,645.13$380.76RVU16C
2016-04-01$1,645.13$380.76RVU16B
2016-01-01$1,645.13$380.76RVU16A
2015-10-01$1,649.69$382.02RVU15D
2015-07-01$1,649.69$382.02RVU15C
2015-04-01$1,641.49$380.12RVU15B
2015-01-01$1,641.49$380.12RVU15A
2014-10-01$1,598.30$375.44RVU14D
2014-07-01$1,598.30$375.44RVU14C
2014-04-01$1,598.30$375.44RVU14B
2014-01-01$1,598.30$375.44RVU14A
2013-10-01$1,699.83$353.60RVU13D
2013-07-01$1,699.83$353.60RVU13C
2013-04-01$1,699.83$353.60RVU13B
2013-01-01$1,699.83$353.60RVU13AR

Price 36254 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

36254 billing questions

When should 36254 be selected instead of 36252?

Use 36254 when selective catheter placement reaches second-order or more distal renal artery branches on both sides. Code 36252 describes bilateral study at the main renal artery level.

Can 36254 be reported when distal branch selection is unilateral?

No. The bilateral code requires the qualifying branch-level service on both sides; 36253 is the unilateral second-order-or-more code.

Is renal angiographic imaging separately reported?

The diagnostic renal angiographic imaging is included in this service. The record should support the selective catheter positions and the imaging performed.

Should modifier 50 be appended?

The code is already priced as bilateral, and modifier 50 does not increase payment.

How does the multiple procedure reduction affect 36254?

When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.

What are the assistant and global-period rules?

The code has a 0-day global period, so same-day preoperative and postoperative care is included. Assistant-at-surgery payment is restricted, and 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 36254PPRRVU2026_Oct_nonQPP.csv, line 4,462 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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