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CPT code 36640: Arterial cannulation, extracorporeal circulation or standby2026 Medicare rate & RVUs

Reports arterial catheter placement or cannulation for extracorporeal circulation or standby access, such as arterial access established for cardiopulmonary bypass.

CMS RVU26DEffective Oct 1, 2026109 payment localities139 Medicare services in 2024

Medicare pays $100.87 for 36640 nationally in a facility.

Medicare rate · 36640

Arterial cannulation, extracorporeal circulation or standby

Office or facility?

Work RVUs
2.05
Total RVUs
3.02
Global days
000

National rate · 2026

$100.87

Facility setting, before claim adjustments.

See every locality for 36640 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 36640 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 36640 covers

This code covers arterial catheter placement or cannulation when the access is for extracorporeal circulation or standby use. A surgeon or other physician may establish the arterial access in an operating room for a procedure such as cardiopulmonary bypass. It is distinct from placing a routine arterial line solely for blood sampling or hemodynamic monitoring.

Report the code when the documented purpose of the arterial access supports extracorporeal circulation or standby use; record the indication and catheterization performed. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and 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 36640 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

36640 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$95.38
AlaskaUnavailable$134.81
ArizonaUnavailable$99.34
ArkansasUnavailable$94.69
Atlanta, GAUnavailable$102.46
Austin, TXUnavailable$102.08
Bakersfield, CAUnavailable$103.00
Baltimore area, MDUnavailable$105.10
Beaumont, TXUnavailable$98.04
Brazoria, TXUnavailable$100.14

36640 rates by state

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

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Local rates. Clear comparisons.

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

View every state and territory as a table
36640 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 36640 rate is calculated

Each of 36640’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 · 36640

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.05

2.05 RVUs× 1.000 GPCI

Practice expense0.83

0.83 RVUs× 1.000 GPCI

Malpractice0.14

0.14 RVUs× 1.000 GPCI

Adjusted RVUs

3.0200

Conversion factor

$33.4009

Medicare rate

$100.87

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

Payment rules and modifiers for 36640

The CMS indicators that decide how 36640 is paid alongside other services.

CMS payment indicators · 36640

Arterial cannulation, extracorporeal circulation or standby

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)0The 150% bilateral adjustment doesn’t apply.
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

36640 without 51 · national facility

$100.87

Arterial cannulation, extracorporeal circulation or standby

36640-51 · Second procedure: 50%

$50.44

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

36640 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 36640

    Arterial cannulation, extracorporeal circulation or standby2.05 wRVU

    Not priced

  • 36620

    Arterial catheter, percutaneous placement0.98 wRVU

    Not priced

  • 36625

    Arterial catheter, cutdown approach2.06 wRVU

    Not priced

  • 36600

    Arterial blood draw, percutaneous puncture0.31 wRVU

    $27.39

How to choose

36620Arterial catheterPercutaneous placement
Choose 36620 for percutaneous arterial catheterization for sampling, monitoring, or transfusion. Choose 36640 when arterial access is for extracorporeal circulation or standby.
36625Arterial catheterCutdown approach
Code 36625 describes arterial catheterization by cutdown for sampling, monitoring, or transfusion. The purpose of access, not simply the presence of an arterial catheter, distinguishes it from 36640.
36600Arterial blood drawPercutaneous puncture
Code 36600 is for arterial puncture to obtain a blood sample. It does not describe placement or cannulation of an arterial catheter for extracorporeal circulation or standby.

Codes related to 36640

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

Codes related to 36640
CodeHow it relatesNational office range
Used instead
36600Arterial blood draw, percutaneous punctureArterial puncture for a blood sample, rather than catheter placement for extracorporeal circulation or standby.$24.76–$35.45
36620Arterial catheter, percutaneous placementPercutaneous arterial catheterization for sampling, monitoring, or transfusion.No office rate
36625Arterial catheter, cutdown approachArterial catheterization by cutdown for sampling, monitoring, or transfusion.No office rate
36660Arterial catheter, newborn umbilical arteryUmbilical artery catheterization in a newborn for diagnosis or therapy.No office rate

36640 billing questions

How is this different from 36620?

Use 36640 for arterial access intended for extracorporeal circulation or standby use. Code 36620 describes percutaneous arterial catheterization for sampling, monitoring, or transfusion.

Can a one-time arterial blood draw be reported with this code?

No. A single arterial puncture to withdraw blood is represented by 36600; 36640 concerns arterial catheter placement or cannulation for extracorporeal circulation or standby.

What documentation supports reporting 36640?

Document the reason for arterial access and the catheterization or cannulation performed. The record should show its role in extracorporeal circulation or standby use, rather than routine arterial-line monitoring alone.

Can modifier 50 be used if access is placed on both sides?

No. CMS identifies bilateral adjustment as inapplicable for this code; the descriptor or anatomy makes modifier 50 inappropriate.

How does Medicare handle this code with other procedures in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. The code has a 0-day global period, which includes same-day preoperative and postoperative care.

Can an assistant, co-surgeon, or surgical team also be paid for this service?

Medicare does not pay an assistant at surgery 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 36640PPRRVU2026_Oct_nonQPP.csv, line 4,540 (RVU26D)

Open CMS sourceHow we calculate rates

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