CPT code 36860: Cannula declotting, external cannula, no revision2026 Medicare rate & RVUs in Madera, CA

Reports clearing clot from an external cannula associated with an arteriovenous shunt or fistula when the access itself is not revised.

CMS RVU26DEffective Oct 1, 2026One payment locality

In Madera, CA, Medicare pays $268.26 for 36860 in the office and $92.91 when it’s performed in a hospital or facility.

$268.26Office (non-facility)
$92.91Hospital or facility
+3.9%vs the national office rate ($258.19)

Check a contract rate as a % of Medicare · 36860 nationwide

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

We’ll open 36860 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Madera, CA
  2. What 36860 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Madera, CA compares for 36860

Across 109 of 109 payment localities, the office rate for 36860 runs from $225.16 in Arkansas to $335.14 in San Benito County, CA. Madera, CA pays $268.26. The RVUs are the same everywhere; the geographic indexes change the dollars.

36860 in Madera, CA vs other payment areas
  1. Madera, CA · this page$268.26
  2. Bakersfield, CA · California$269.64+$1.38
  3. Chico, CA · California$268.26
  4. El Centro, CA · California$268.35+$0.09
  5. Fresno, CA · California$268.26
  6. Hanford, CA · California$268.26
  7. Los Angeles, CA · California$287.30+$19.04

Other areas in California first, then benchmark localities. Bars start at $0.

Every other payment area

36860 in every other Medicare payment locality
Payment localityOfficeFacility
Merced, CACalifornia$268.26$92.91
Modesto, CACalifornia$268.26$92.91
Napa, CACalifornia$309.80$98.93
Oxnard, CACalifornia$285.58$96.47
Redding, CACalifornia$268.26$92.91
Rest of CaliforniaCalifornia$268.26$92.91
Riverside, CACalifornia$273.73$98.38
Sacramento, CACalifornia$281.28$95.21

36860 rates by state

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

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.

$225.16

$301.70

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
36860 office rate range by state
State / territoryOffice rate rangeLocalities
AK$294.691
AL$228.831
AR$225.161
AZ$250.291
CA$268.26–$335.1429
CO$266.491
CT$276.601
DC$294.921
DE$254.691
FL$259.03–$291.443
GA$242.49–$264.622
GU$275.091
HI$275.091
IA$232.981
ID$235.161
IL$252.49–$281.594
IN$236.611
KS$232.871
KY$237.241
LA$237.27–$250.142
MA$265.09–$293.082
MD$259.56–$294.923
ME$237.69–$250.322
MI$245.10–$263.732
MN$251.291
MO$233.50–$249.793
MS$229.321
MT$258.151
NC$240.271
ND$248.071
NE$234.071
NH$263.261
NJ$278.62–$291.582
NM$247.031
NV$255.521
NY$244.35–$310.185
OH$243.041
OK$235.591
OR$252.43–$274.382
PA$242.85–$269.862
PR$259.871
RI$263.391
SC$242.281
SD$246.881
TN$234.311
TX$241.17–$266.578
UT$245.911
VA$250.19–$294.922
VI$259.871
VT$248.021
WA$264.28–$298.232
WI$239.021
WV$242.521
WY$253.761

See 36860 in every payment locality

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

Office or facility?

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.

The exact Madera, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

4,560

Code
36860
Physician work
1.96
Practice expense
5.26
Malpractice
0.51

GPCI2026.csv

14

Locality
Madera, CA
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office calculation for 36860 in Madera, CA
ComponentRVULocality factorAdjusted
Physician work1.96× 1.0171.9933
Practice expense5.26× 1.0965.7650
Malpractice0.51× 0.5360.2734
Total RVUs8.0316
Conversion factor× 33.4009

Office rate, Madera, CA$268.26

Office: (1.96 × 1.017 + 5.26 × 1.096 + 0.51 × 0.536) × $33.4009 = $268.26

Facility: (1.96 × 1.017 + 0.47 × 1.096 + 0.51 × 0.536) × $33.4009 = $92.91

Open 36860 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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%).

When to use modifier 51

How 36860 has changed in Madera, CA

36860 · Office / nonfacility

$268.26

Effective 2026-10-01

The base rate is $36.47 higher than on 2025-10-01, moving from $231.79 to $268.26 (15.7%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
  1. January 1, 2026

    RVU26A

    $231.79changed to$268.26

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.01 changed to 1.96
    • Practice expense RVU 4.43 changed to 5.26
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $239.26changed to$231.79

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.45 changed to 4.43

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $235.35changed to$239.26

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $242.63changed to$235.35

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.46 changed to 4.45
    • Work GPCI 1.021 changed to 1.014
    • Practice expense GPCI 1.079 changed to 1.093
    • Malpractice GPCI 0.579 changed to 0.560
  5. January 1, 2023

    RVU23A

    $247.82changed to$242.63

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.50 changed to 4.46
    • Work GPCI 1.027 changed to 1.021
    • Practice expense GPCI 1.065 changed to 1.079
    • Malpractice GPCI 0.597 changed to 0.579

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $257.06changed to$247.82

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.71 changed to 4.50
    • Malpractice RVU 0.48 changed to 0.51

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $260.24changed to$257.06

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.55 changed to 4.71
    • Malpractice RVU 0.49 changed to 0.48
    • Work GPCI 1.024 changed to 1.027
    • Practice expense GPCI 1.070 changed to 1.065
    • Malpractice GPCI 0.580 changed to 0.597

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $264.75changed to$260.24

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.68 changed to 4.55
    • Malpractice RVU 0.48 changed to 0.49
    • Work GPCI 1.020 changed to 1.024
    • Practice expense GPCI 1.074 changed to 1.070
    • Malpractice GPCI 0.562 changed to 0.580

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $230.64changed to$264.75

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.80 changed to 4.68
    • Malpractice RVU 0.49 changed to 0.48

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $223.41changed to$230.64

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.76 changed to 3.80
    • Malpractice RVU 0.18 changed to 0.49
    • Work GPCI 1.024 changed to 1.020
    • Practice expense GPCI 1.079 changed to 1.074
    • Malpractice GPCI 0.610 changed to 0.562

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    No ratechanged to$223.41

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$268.26$92.91RVU26D
2026-07-01$268.26$92.91RVU26C
2026-04-01$268.26$92.91RVU26B
2026-01-01$268.26$92.91RVU26A
2025-10-01$231.79$102.03RVU25D
2025-07-01$231.79$102.03RVU25C
2025-04-01$231.79$102.03RVU25B
2025-01-01$231.79$102.03RVU25A
2024-10-01$239.26$104.28RVU24D
2024-07-01$239.26$104.28RVU24C
2024-04-01$239.26$104.28RVU24B
2024-03-09$239.26$104.28RVU24AR
2024-01-01$235.35$102.57RVU24A
2023-10-01$242.63$106.97RVU23D
2023-07-01$242.63$106.97RVU23C
2023-04-01$242.63$106.97RVU23B
2023-01-01$242.63$106.97RVU23A
2022-10-01$247.82$109.61RVU22D
2022-07-01$247.82$109.61RVU22C
2022-04-01$247.82$109.61RVU22B
2022-01-01$247.82$109.61RVU22A
2021-10-01$257.06$109.90RVU21D
2021-07-01$257.06$109.90RVU21C
2021-04-01$257.06$109.90RVU21B
2021-01-01$257.06$109.90RVU21A
2020-10-01$260.24$112.73RVU20D
2020-07-01$260.24$112.73RVU20C
2020-04-01$260.24$112.73RVU20B
2020-01-01$260.24$112.73RVU20A
2019-10-01$264.75$111.09RVU19D
2019-07-01$264.75$111.09RVU19C
2019-04-01$264.75$111.09RVU19B
2019-01-01$264.75$111.09RVU19A
2018-10-01$230.64$120.84RVU18D
2018-07-01$230.64$120.84RVU18C
2018-04-01$230.64$120.84RVU18B
2018-01-01$230.64$120.84RVU18AR1
2017-10-01$223.41$116.92RVU17D
2017-07-01$223.41$116.92RVU17C
2017-04-01$223.41$116.92RVU17B
2017-01-01$223.41$116.92RVU17A
2016-10-01Rate data unavailableRate data unavailableRVU16D
2016-07-01Rate data unavailableRate data unavailableRVU16C
2016-04-01Rate data unavailableRate data unavailableRVU16B
2016-01-01Rate data unavailableRate data unavailableRVU16A
2015-10-01Rate data unavailableRate data unavailableRVU15D
2015-07-01Rate data unavailableRate data unavailableRVU15C
2015-04-01Rate data unavailableRate data unavailableRVU15B
2015-01-01Rate data unavailableRate data unavailableRVU15A
2014-10-01Rate data unavailableRate data unavailableRVU14D
2014-07-01Rate data unavailableRate data unavailableRVU14C
2014-04-01Rate data unavailableRate data unavailableRVU14B
2014-01-01Rate data unavailableRate data unavailableRVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 36860 for an earlier date of service

Where the Madera, CA rate applies

Madera, CA is a Medicare payment area, not a city. Our Census mapping connects it to 17 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • Madera
  • Ahwahnee
  • Bass Lake
  • Bonadelle Ranchos
  • Chowchilla
  • Coarsegold
  • Fairmead
  • La Vina

Browse all communities in California

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

Show the CMS file lines behind this rate
RVUs for 36860PPRRVU2026_Oct_nonQPP.csv, line 4,560 (RVU26D)
Geographic factors for Madera, CAGPCI2026.csv, line 14 (RVU26D)

Open CMS sourceHow we calculate rates

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