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CPT code 36821: Dialysis access, direct artery-to-vein connection2026 Medicare rate & RVUs

Report this code when a surgeon creates hemodialysis access by directly connecting a native artery and vein without an interposed graft.

CMS RVU26DEffective Oct 1, 2026109 payment localities22.6K Medicare services in 2024

Medicare pays $600.88 for 36821 nationally in a facility.

Medicare rate · 36821

Dialysis access, direct artery-to-vein connection

Office or facility?

Work RVUs
11.6
Total RVUs
17.99
Global days
090

National rate · 2026

$600.88

Facility setting, before claim adjustments.

See every locality for 36821 →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 36821 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 36821 covers

A vascular surgeon creates a direct connection between a native artery and a native vein to establish an arteriovenous access for hemodialysis. The procedure is generally performed in an operating room, including hospital outpatient or inpatient settings. The operative report should identify the vessels and site, describe the direct connection, and make clear that no graft was used.

Select this code when the documented construction is a direct artery-to-vein anastomosis, rather than a site-specific technique or a graft-based access. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur 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. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team-surgery billing 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 36821 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

36821 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$543.76
AlaskaUnavailable$757.83
ArizonaUnavailable$583.13
ArkansasUnavailable$536.89
Atlanta, GAUnavailable$623.69
Austin, TXUnavailable$597.09
Bakersfield, CAUnavailable$580.75
Baltimore area, MDUnavailable$638.82
Beaumont, TXUnavailable$583.55
Brazoria, TXUnavailable$581.27

36821 rates by state

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

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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.

View every state and territory as a table
36821 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 36821 rate is calculated

Each of 36821’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 · 36821

RVUs × geographic indexes × conversion factor

Office or facility?

Work11.60

11.60 RVUs× 1.000 GPCI

Practice expense3.44

3.44 RVUs× 1.000 GPCI

Malpractice2.95

2.95 RVUs× 1.000 GPCI

Adjusted RVUs

17.9900

Conversion factor

$33.4009

Medicare rate

$600.88

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

Payment rules and modifiers for 36821

36821 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 36821

Dialysis access, direct artery-to-vein connection

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 · 36821

Dialysis access, direct artery-to-vein connection

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

36821 without 51 · national facility

$600.88

Dialysis access, direct artery-to-vein connection

36821-51 · Second procedure: 50%

$300.44

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

36821 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 36821

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

    Not priced

  • 36820

    AV fistula, forearm vein transposition12.74 wRVU

    Not priced

  • 36825

    Dialysis access, autologous vein conduit13.82 wRVU

    Not priced

  • 36830

    AV graft creation, nonautologous graft11.73 wRVU

    Not priced

How to choose

36820AV fistulaForearm vein transposition
Use 36820 for the forearm-vein access technique. This code describes a direct artery-to-vein connection at any site, so compare the documented anatomy and construction.
36825Dialysis accessAutologous vein conduit
This code is for a direct native-vessel connection; 36825 is used when an autogenous graft is used to construct the access.
36830AV graft creationNonautologous graft
This code describes direct native-vessel access. Use 36830 when the access is constructed with a nonautologous graft.

Codes related to 36821

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

Codes related to 36821
CodeHow it relatesNational office range
Same family
36818AV fistula creation, upper-arm cephalic transpositionSite-specific upper-arm cephalic-vein access technique.No office rate
36819Dialysis access, basilic vein transpositionSite-specific upper-arm basilic-vein access technique.No office rate
36820AV fistula, forearm vein transpositionForearm-vein access technique; distinguish by documented construction.No office rate
Used instead
36825Dialysis access, autologous vein conduitCreates access using an autogenous graft rather than a direct connection.No office rate
36830AV graft creation, nonautologous graftCreates access using a nonautologous graft rather than a direct connection.No office rate

36821 billing questions

How is this code distinguished from 36820?

This code describes a direct artery-to-vein connection at any site. Code 36820 identifies the forearm-vein technique; use the operative details and applicable site-specific code description to select between them.

Can this code be used when a graft is placed?

No. It describes a direct connection between native vessels without an interposed graft. A graft-based access is represented by a different code, with the choice depending on graft material.

Are the preoperative visit and postoperative care separately reported?

The day-before preoperative visit and related postoperative care during the 90-day global period are included in this surgery's global payment.

Can modifier 50 be used for access creation on both sides?

Modifier 50 is inappropriate for this code. Report the service based on the documented operative site and procedure.

How are assistant and co-surgeon services handled?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team-surgery billing 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 36821PPRRVU2026_Oct_nonQPP.csv, line 4,549 (RVU26D)

Open CMS sourceHow we calculate rates

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