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

CMS doesn’t publish an office rate for 36821 in California.

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

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 in California

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

29 of 29 payment localities

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.

Payment rules and modifiers for 36821

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

What modifiers do to the payment

When to use modifier 51

36821 compared with similar codes

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.

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

Open CMS sourceHow we calculate rates