Billing code 36226: Vertebral angiographyMedicare rate & RVUs
Reports direct selective catheterization of one vertebral artery with angiographic evaluation of its cervical and intracranial circulation.
Medicare pays $2,285.96 for 36226 nationally in the office and $329.33 in a hospital or facility. Local office rates run $1,970.26–$3,170.72.
Medicare rate · 36226
Vertebral angiography
- Work RVUs
- 6.09
- Total RVUs
- 68.44
- Global days
- 000
National rate · 2026
$2,285.96
Office setting, before claim adjustments.
See every locality for 36226 →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.
On this page 10 sections
What 36226 covers
Code 36226 covers advancing a catheter directly into a vertebral artery and imaging the ipsilateral vertebral circulation in the neck and intracranially. Neurointerventional radiologists, neuroradiologists, neurosurgeons, and other physicians may perform the study in a hospital angiography suite or another appropriately equipped setting. It is used in diagnostic cerebral angiography evaluating conditions such as vertebrobasilar stenosis, arterial dissection, aneurysm, or vascular malformation. The service includes the selective catheter placement and the associated angiographic imaging of that circulation.
Report one unit for each side selectively studied, with the catheter position and imaged territory documented. A catheter left in the subclavian artery, rather than advanced directly into the vertebral artery, points to 36225 instead. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. 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. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery 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 36226 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$1970.26 to $3170.72
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $2,005.82 | $293.78 |
| Alaska* | $2,490.07 | $406.26 |
| Arizona | $2,214.15 | $318.18 |
| Arkansas | $1,970.26 | $289.52 |
| Atlanta | $2,331.75 | $343.82 |
| Austin | $2,396.12 | $326.01 |
| Bakersfield | $2,458.52 | $314.05 |
| Baltimore/Surr. Cntys | $2,451.76 | $352.30 |
| Beaumont | $2,099.75 | $319.22 |
| Brazoria | $2,255.31 | $316.30 |
| Chicago | $2,380.52 | $414.11 |
| Chico | $2,453.43 | $308.97 |
| Colorado | $2,403.53 | $321.68 |
| Connecticut | $2,458.91 | $351.63 |
| Dallas | $2,270.61 | $321.81 |
| Dc + Md/Va Suburbs | $2,663.47 | $358.56 |
| Delaware | $2,256.28 | $323.13 |
| Detroit | $2,259.31 | $371.16 |
| East St. Louis | $2,189.51 | $389.42 |
| El Centro | $2,453.75 | $309.29 |
| Fort Lauderdale | $2,364.01 | $381.95 |
| Fort Worth | $2,251.26 | $322.03 |
| Fresno | $2,453.43 | $308.97 |
| Galveston | $2,262.43 | $319.50 |
| Hanford-Corcoran | $2,453.43 | $308.97 |
| Hawaii, Guam | $2,535.48 | $310.80 |
| Houston | $2,297.57 | $354.64 |
| Idaho | $2,090.69 | $290.59 |
| Indiana | $2,105.65 | $291.86 |
| Iowa | $2,075.72 | $285.41 |
| Kansas | $2,060.38 | $291.59 |
| Kentucky | $2,056.46 | $317.02 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $2,642.12 | $327.43 |
| Madera | $2,453.43 | $308.97 |
| Manhattan | $2,663.54 | $389.94 |
| Merced | $2,453.43 | $308.97 |
| Metropolitan Boston | $2,678.82 | $342.61 |
| Metropolitan Kansas City | $2,161.36 | $324.09 |
| Metropolitan Philadelphia | $2,384.75 | $347.90 |
| Metropolitan St. Louis | $2,189.20 | $326.50 |
| Miami | $2,466.77 | $429.92 |
| Minnesota | $2,299.34 | $285.98 |
| Mississippi | $1,988.66 | $304.01 |
| Modesto | $2,453.43 | $308.97 |
| Montana** | $2,285.83 | $329.20 |
| Napa | $2,909.08 | $330.25 |
| Nebraska | $2,090.65 | $284.69 |
| Nevada** | $2,277.27 | $318.69 |
| New Hampshire | $2,360.70 | $323.85 |
| New Mexico | $2,131.32 | $337.09 |
| New Orleans | $2,175.59 | $334.41 |
| North Carolina | $2,127.57 | $302.04 |
| North Dakota** | $2,247.86 | $291.24 |
| Northern Nj | $2,626.08 | $356.40 |
| Nyc Suburbs/Long Island | $2,735.42 | $408.99 |
| Ohio | $2,110.87 | $324.47 |
| Oklahoma | $2,055.69 | $308.42 |
| Oxnard-Thousand Oaks-Ventura | $2,634.83 | $322.10 |
| Portland | $2,496.84 | $323.03 |
| Poughkpsie/N Nyc Suburbs | $2,500.33 | $357.82 |
| Puerto Rico | $2,307.20 | $329.05 |
| Queens | $2,694.67 | $381.94 |
| Redding | $2,453.43 | $308.97 |
| Rest Of California | $2,453.43 | $308.97 |
| Rest Of Florida | $2,229.40 | $358.87 |
| Rest Of Georgia | $2,080.28 | $334.97 |
| Rest Of Illinois | $2,146.46 | $360.06 |
| Rest Of Louisiana | $2,051.15 | $319.53 |
| Rest Of Maine | $2,100.24 | $300.15 |
| Rest Of Maryland | $2,306.95 | $326.85 |
| Rest Of Massachusetts | $2,383.17 | $322.84 |
| Rest Of Michigan | $2,118.63 | $332.23 |
| Rest Of Missouri | $2,005.75 | $319.14 |
| Rest Of New Jersey | $2,486.01 | $349.37 |
| Rest Of New York | $2,165.99 | $307.20 |
| Rest Of Oregon | $2,258.84 | $310.04 |
| Rest Of Pennsylvania | $2,116.92 | $320.74 |
| Rest Of Texas | $2,176.80 | $319.96 |
| Rest Of Washington | $2,380.25 | $319.93 |
| Rhode Island | $2,349.50 | $328.31 |
| Riverside-San Bernardino-Ontario | $2,473.96 | $329.50 |
| Sacramento-Roseville-Folsom | $2,592.53 | $316.97 |
| Salinas | $2,583.44 | $315.71 |
| San Diego-Chula Vista-Carlsbad | $2,658.30 | $318.17 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $3,098.14 | $339.30 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $3,095.96 | $337.12 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $3,170.72 | $349.26 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $3,161.80 | $340.35 |
| San Luis Obispo-Paso Robles | $2,540.22 | $311.62 |
| Santa Cruz-Watsonville | $2,694.43 | $317.13 |
| Santa Maria-Santa Barbara | $2,596.95 | $315.53 |
| Santa Rosa-Petaluma | $2,722.50 | $319.77 |
| Seattle (King Cnty) | $2,742.57 | $341.79 |
| South Carolina | $2,122.94 | $315.02 |
| South Dakota** | $2,243.38 | $286.75 |
| Southern Maine | $2,244.13 | $305.11 |
| Stockton | $2,453.43 | $308.97 |
| Suburban Chicago | $2,391.39 | $381.93 |
| Tennessee | $2,072.59 | $294.02 |
| Utah | $2,158.31 | $319.08 |
| Vallejo | $2,905.93 | $327.10 |
| Vermont | $2,234.09 | $297.03 |
| Virgin Islands | $2,307.20 | $329.05 |
| Virginia | $2,232.79 | $309.43 |
| Visalia | $2,453.43 | $308.97 |
| West Virginia | $2,049.18 | $348.88 |
| Wisconsin | $2,156.81 | $282.36 |
| Wyoming** | $2,269.28 | $312.66 |
| Yuba City | $2,453.43 | $308.97 |
36226 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.
$1,970.26
$2,812.08
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $2,490.07 | 1 |
| AL | $2,005.82 | 1 |
| AR | $1,970.26 | 1 |
| AZ | $2,214.15 | 1 |
| CA | $2,453.43–$3,170.72 | 29 |
| CO | $2,403.53 | 1 |
| CT | $2,458.91 | 1 |
| DC | $2,663.47 | 1 |
| DE | $2,256.28 | 1 |
| FL | $2,229.40–$2,466.77 | 3 |
| GA | $2,080.28–$2,331.75 | 2 |
| GU | $2,535.48 | 1 |
| HI | $2,535.48 | 1 |
| IA | $2,075.72 | 1 |
| ID | $2,090.69 | 1 |
| IL | $2,146.46–$2,391.39 | 4 |
| IN | $2,105.65 | 1 |
| KS | $2,060.38 | 1 |
| KY | $2,056.46 | 1 |
| LA | $2,051.15–$2,175.59 | 2 |
| MA | $2,383.17–$2,678.82 | 2 |
| MD | $2,306.95–$2,663.47 | 3 |
| ME | $2,100.24–$2,244.13 | 2 |
| MI | $2,118.63–$2,259.31 | 2 |
| MN | $2,299.34 | 1 |
| MO | $2,005.75–$2,189.20 | 3 |
| MS | $1,988.66 | 1 |
| MT | $2,285.83 | 1 |
| NC | $2,127.57 | 1 |
| ND | $2,247.86 | 1 |
| NE | $2,090.65 | 1 |
| NH | $2,360.70 | 1 |
| NJ | $2,486.01–$2,626.08 | 2 |
| NM | $2,131.32 | 1 |
| NV | $2,277.27 | 1 |
| NY | $2,165.99–$2,735.42 | 5 |
| OH | $2,110.87 | 1 |
| OK | $2,055.69 | 1 |
| OR | $2,258.84–$2,496.84 | 2 |
| PA | $2,116.92–$2,384.75 | 2 |
| PR | $2,307.20 | 1 |
| RI | $2,349.50 | 1 |
| SC | $2,122.94 | 1 |
| SD | $2,243.38 | 1 |
| TN | $2,072.59 | 1 |
| TX | $2,099.75–$2,396.12 | 8 |
| UT | $2,158.31 | 1 |
| VA | $2,232.79–$2,663.47 | 2 |
| VI | $2,307.20 | 1 |
| VT | $2,234.09 | 1 |
| WA | $2,380.25–$2,742.57 | 2 |
| WI | $2,156.81 | 1 |
| WV | $2,049.18 | 1 |
| WY | $2,269.28 | 1 |
How the 36226 rate is calculated
Each of 36226’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 · 36226
RVUs × geographic indexes × conversion factor
Work6.09
6.09 RVUs× 1.000 GPCI
Practice expense60.43
60.43 RVUs× 1.000 GPCI
Malpractice1.92
1.92 RVUs× 1.000 GPCI
Adjusted RVUs
68.4400
Conversion factor
$33.4009
Medicare rate
$2,285.96
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 36226
The CMS indicators that decide how 36226 is paid alongside other services.
CMS payment indicators · 36226
Vertebral angiography
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 50 · payment effect
With and without the modifier
36226 without 50 · national office
$2,285.96
Vertebral angiography
36226-50 · Bilateral: 150%
$3,428.94
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
36226 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 36225Subclavian angiography
- The catheter position distinguishes the codes: 36226 requires direct vertebral artery selection, while 36225 describes selection of the subclavian artery with imaging of the ipsilateral vertebral circulation.
- 36224Carotid angiography
- 36224 is for selective internal carotid catheterization and carotid circulation imaging; 36226 is for direct vertebral selection and vertebral circulation imaging.
- 36221Aortic arch angiography
- 36221 describes arch-level angiography. It does not represent the direct selective catheter placement into a vertebral artery covered by 36226.
36226 billing questions
How do I distinguish 36226 from 36225?
Use 36226 when the catheter is selectively advanced into the vertebral artery. Use 36225 when it remains in the subclavian artery for imaging of the ipsilateral vertebral circulation.
Does 36226 include the angiographic imaging?
Yes. The code encompasses selective catheter placement and angiography of the ipsilateral vertebral artery’s cervical and intracranial circulation.
How should bilateral vertebral studies be reported?
Report the bilateral service with modifier 50 when both sides are studied. CMS pays a bilateral procedure at 150%.
What documentation supports reporting 36226?
Document the side, selective catheter position within the vertebral artery, and the cervical and intracranial territory imaged.
Can 36226 be reported with carotid angiography?
It may be part of a multivessel cerebral angiographic examination when the carotid circulation is separately selectively catheterized and imaged. Document each catheter position and the circulation studied.
Can an assistant or co-surgeon be paid for this service?
CMS applies a statutory restriction to assistant-at-surgery payment for this code. Co-surgeons and team surgery 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
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