CPT code 36860: Cannula declotting, external cannula, no revision2026 Medicare rate & RVUs in California
Reports clearing clot from an external cannula associated with an arteriovenous shunt or fistula when the access itself is not revised.
Medicare pays $268.26–$335.14 for 36860 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
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 36860 covers
This service clears thrombus from an external cannula used with an arteriovenous shunt or fistula for hemodialysis. It is distinct from removing clot from the access circuit itself or surgically revising the access. A physician who manages dialysis access, commonly a vascular surgeon or access surgeon, may perform it when cannula obstruction interferes with use of the access.
Report the code when documentation identifies the external cannula as the site of clot and shows that declotting was performed without access revision. Record the access involved, the obstructing clot, the work performed, and the result. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery is not paid; co-surgeon and team-surgery billing 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 36860 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 payment localities
$268.26 to $335.14
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $269.64 | $94.29 |
| Chico, CA | $268.26 | $92.91 |
| El Centro, CA | $268.35 | $93.00 |
| Fresno, CA | $268.26 | $92.91 |
| Hanford, CA | $268.26 | $92.91 |
| Los Angeles, CA | $287.30 | $98.03 |
| Madera, CA | $268.26 | $92.91 |
| Marin County, CA | $327.22 | $101.64 |
| Merced, CA | $268.26 | $92.91 |
| Modesto, CA | $268.26 | $92.91 |
| Napa, CA | $309.80 | $98.93 |
| Oxnard, CA | $285.58 | $96.47 |
| Redding, CA | $268.26 | $92.91 |
| Rest of California | $268.26 | $92.91 |
| Riverside, CA | $273.73 | $98.38 |
| Sacramento, CA | $281.28 | $95.21 |
| Salinas, CA | $280.25 | $94.82 |
| San Benito County, CA | $335.14 | $104.43 |
| San Diego, CA | $286.79 | $95.44 |
| San Francisco, CA | $326.65 | $101.06 |
| San Luis Obispo, CA | $275.82 | $93.59 |
| Santa Clara County, CA | $332.77 | $102.07 |
| Santa Cruz, CA | $289.43 | $95.04 |
| Santa Maria, CA | $281.28 | $94.73 |
| Santa Rosa, CA | $292.31 | $95.84 |
| Stockton, CA | $268.26 | $92.91 |
| Vallejo, CA | $308.97 | $98.10 |
| Visalia, CA | $268.26 | $92.91 |
| Yuba City, CA | $268.26 | $92.91 |
How the 36860 rate is calculated
Each of 36860’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 · 36860
RVUs × geographic indexes × conversion factor
Work1.96
1.96 RVUs× 1.000 GPCI
Practice expense5.26
5.26 RVUs× 1.000 GPCI
Malpractice0.51
0.51 RVUs× 1.000 GPCI
Adjusted RVUs
7.7300
Conversion factor
$33.4009
Medicare rate
$258.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 36860
The CMS indicators that decide how 36860 is paid alongside other services.
CMS payment indicators · 36860
Cannula declotting, external cannula, no revision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
36860 without 51 · national office
$258.19
Cannula declotting, external cannula, no revision
36860-51 · Second procedure: 50%
$129.10
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%).
36860 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 36831Fistula thrombectomyOpen, without revision
- Choose 36860 when declotting is confined to the external cannula and the access is not revised. Choose 36831 for open thrombectomy of the arteriovenous fistula.
- 36861Cannula declottingInternal cannula
- These codes distinguish external-cannula declotting without revision from related cannula declotting associated with revision. Base selection on the documented procedure performed.
- 36833Fistula revisionOpen, with thrombectomy
- Code 36833 addresses revision of the fistula with thrombectomy; 36860 is limited to declotting the external cannula without access revision.
36860 billing questions
How is this different from 36831?
Use 36860 for clot cleared from the external cannula without revising the access. Code 36831 describes open thrombectomy of the arteriovenous fistula itself.
When would 36861 be considered instead?
36861 is the related cannula-declotting code associated with revision. This code is for declotting the external cannula without access revision.
What documentation supports reporting 36860?
Document that the clot was in the external cannula, the declotting work performed, and whether the access was revised. The record should distinguish cannula clearing from thrombectomy of the access.
Is same-day care included in the payment?
Yes. The code has a 0-day global period, which includes same-day preoperative and postoperative care.
Can modifier 50 or an assistant-at-surgery claim be reported?
Modifier 50 is inappropriate for this code. CMS does not pay an assistant at surgery for it.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full; other procedures are subject to the standard multiple procedure reduction. Co-surgeon and team-surgery billing 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
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