CPT code 36821: Dialysis access, direct artery-to-vein connection2026 Medicare rate & RVUs in Florida
Report this code when a surgeon creates hemodialysis access by directly connecting a native artery and vein without an interposed graft.
CMS doesn’t publish an office rate for 36821 in Florida.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | Unavailable | $681.99 |
| Miami, FL | Unavailable | $756.25 |
| Rest of Florida | Unavailable | $645.39 |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share 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.
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%).
36821 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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