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CPT code 36818: AV fistula creation, upper-arm cephalic transposition2026 Medicare rate & RVUs

Report this open operation to create hemodialysis access by transposing an upper-arm cephalic vein and connecting it to an artery.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.9K Medicare services in 2024

Medicare pays $628.60 for 36818 nationally in a facility.

Medicare rate · 36818

AV fistula creation, upper-arm cephalic transposition

Office or facility?

Work RVUs
12.08
Total RVUs
18.82
Global days
090

National rate · 2026

$628.60

Facility setting, before claim adjustments.

See every locality for 36818 →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 36818 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 36818 covers

A vascular surgeon creates an arteriovenous access for hemodialysis by mobilizing and transposing the cephalic vein in the upper arm, then connecting it to an artery. The transposed vein provides a superficial segment for later dialysis cannulation. This operation is generally performed in a hospital operating room for a patient who needs durable vascular access.

Select 36818 when the access is created using an upper-arm cephalic vein transposition; document the vessel, location, and operative steps. The service has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is 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 36818 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

36818 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$568.99
AlaskaUnavailable$792.62
ArizonaUnavailable$610.11
ArkansasUnavailable$561.82
Atlanta, GAUnavailable$652.26
Austin, TXUnavailable$624.95
Bakersfield, CAUnavailable$608.27
Baltimore area, MDUnavailable$668.20
Beaumont, TXUnavailable$610.28
Brazoria, TXUnavailable$608.31

36818 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
36818 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 36818 rate is calculated

Each of 36818’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 · 36818

RVUs × geographic indexes × conversion factor

Office or facility?

Work12.08

12.08 RVUs× 1.000 GPCI

Practice expense3.69

3.69 RVUs× 1.000 GPCI

Malpractice3.05

3.05 RVUs× 1.000 GPCI

Adjusted RVUs

18.8200

Conversion factor

$33.4009

Medicare rate

$628.60

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

Payment rules and modifiers for 36818

36818 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 36818

AV fistula creation, upper-arm cephalic transposition

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are 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)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.84/0.07Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 36818

AV fistula creation, upper-arm cephalic transposition

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

36818 without 51 · national facility

$628.60

AV fistula creation, upper-arm cephalic transposition

36818-51 · Second procedure: 50%

$314.30

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

36818 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 36818

    AV fistula creation, upper-arm cephalic transposition12.08 wRVU

    Not priced

  • 36819

    Dialysis access, basilic vein transposition12.96 wRVU

    Not priced

  • 36821

    Dialysis access, direct artery-to-vein connection11.6 wRVU

    Not priced

  • 36825

    Dialysis access, autologous vein conduit13.82 wRVU

    Not priced

How to choose

36819Dialysis accessBasilic vein transposition
Choose 36818 for an upper-arm cephalic vein transposition; choose 36819 when the upper-arm basilic vein is used.
36821Dialysis accessDirect artery-to-vein connection
36821 describes direct open artery-to-vein access creation. 36818 is specific to creating access with upper-arm cephalic vein transposition.
36825Dialysis accessAutologous vein conduit
36825 uses an autogenous graft to create access. 36818 uses the patient's transposed upper-arm cephalic vein.

Codes related to 36818

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

Codes related to 36818
CodeHow it relatesNational office range
Same family
36819Dialysis access, basilic vein transpositionUpper-arm access creation using a basilic vein rather than the cephalic vein.No office rate
36820AV fistula, forearm vein transpositionVein-transposition access creation in the forearm rather than the upper arm.No office rate
Used instead
36821Dialysis access, direct artery-to-vein connectionDirect open artery-to-vein access creation without the upper-arm cephalic transposition approach.No office rate
36825Dialysis access, autologous vein conduitCreates dialysis access with an autogenous graft instead of transposing the cephalic vein.No office rate
36830AV graft creation, nonautologous graftCreates access with a nonautogenous graft rather than a transposed cephalic vein.No office rate

36818 billing questions

How does 36818 differ from 36819?

36818 describes access creation using an upper-arm cephalic vein transposition. 36819 is the corresponding upper-arm procedure using a basilic vein.

Is the vein transposition part of the fistula creation service?

Yes. The code represents creation of the access using upper-arm cephalic vein transposition, including the anastomosis that establishes the fistula.

Should modifier 50 be reported for access created in both arms?

No. CMS identifies bilateral adjustment as inappropriate for this code. Modifier 50 should not be used.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is 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 36818PPRRVU2026_Oct_nonQPP.csv, line 4,546 (RVU26D)

Open CMS sourceHow we calculate rates

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