Billing code 36227: External carotid angiographyMedicare rate & RVUs
Reports selective catheter placement in an external carotid artery with angiography of its circulation, including intracranial imaging when performed.
Medicare pays $273.55 for 36227 nationally in the office and $108.22 in a hospital or facility. Local office rates run $237.12–$352.17.
Medicare rate · 36227
External carotid angiography
Swap in your local Medicare rate.
- Work RVUs
- 2.04
- Total RVUs
- 8.19
- Global days
- ZZZ
National rate · 2026
$273.55
Office setting, before claim adjustments.
See every locality for 36227 → · 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 36227 covers
A physician, commonly an interventional radiologist or neurointerventional specialist, advances a catheter selectively into an external carotid artery and performs angiography of that artery’s circulation. The study may help evaluate head and neck vascular findings, such as a suspected vascular lesion or bleeding source, and may be performed during a diagnostic or interventional angiography session. Intracranial imaging is included when performed as part of this external carotid study.
Report 36227 as an add-on with an appropriate primary cervicocerebral angiography procedure, not by itself. Documentation should identify the catheterized external carotid artery, the angiographic work performed, and the clinical findings supporting the study. CMS treats payment for this add-on as within the primary procedure’s global period. For a bilateral procedure reported with modifier 50, CMS pays 150% under the supplied fee schedule rule.
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 36227 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
$237.12 to $352.17
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $241.17 | $96.50 |
| Alaska* | $309.82 | $133.73 |
| Arizona | $264.73 | $104.52 |
| Arkansas | $237.12 | $95.10 |
| Atlanta | $281.06 | $113.08 |
| Austin | $281.87 | $106.95 |
| Bakersfield | $283.99 | $102.79 |
| Baltimore/Surr. Cntys | $293.20 | $115.80 |
| Beaumont | $255.48 | $105.02 |
| Brazoria | $267.67 | $103.82 |
| Chicago | $303.06 | $136.90 |
| Chico | $282.27 | $101.07 |
| Colorado | $281.37 | $105.46 |
| Connecticut | $293.62 | $115.56 |
| Dallas | $270.35 | $105.68 |
| Dc + Md/Va Suburbs | $312.39 | $117.62 |
| Delaware | $269.50 | $106.15 |
| Detroit | $282.02 | $122.47 |
| East St. Louis | $280.87 | $128.76 |
| El Centro | $282.38 | $101.18 |
| Fort Lauderdale | $293.48 | $126.00 |
| Fort Worth | $268.79 | $105.77 |
| Fresno | $282.27 | $101.07 |
| Galveston | $269.08 | $104.90 |
| Hanford-Corcoran | $282.27 | $101.07 |
| Hawaii, Guam | $289.58 | $101.60 |
| Houston | $280.98 | $116.80 |
| Idaho | $247.42 | $95.31 |
| Indiana | $248.98 | $95.72 |
| Iowa | $244.85 | $93.57 |
| Kansas | $245.15 | $95.69 |
| Kentucky | $251.32 | $104.33 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $302.67 | $107.08 |
| Madera | $282.27 | $101.07 |
| Manhattan | $320.40 | $128.28 |
| Merced | $282.27 | $101.07 |
| Metropolitan Boston | $309.60 | $112.19 |
| Metropolitan Kansas City | $261.85 | $106.60 |
| Metropolitan Philadelphia | $286.50 | $114.39 |
| Metropolitan St. Louis | $264.78 | $107.38 |
| Miami | $314.28 | $142.17 |
| Minnesota | $263.60 | $93.47 |
| Mississippi | $242.35 | $100.00 |
| Modesto | $282.27 | $101.07 |
| Montana** | $273.51 | $108.18 |
| Napa | $325.58 | $107.67 |
| Nebraska | $245.90 | $93.30 |
| Nevada** | $270.11 | $104.61 |
| New Hampshire | $278.37 | $106.26 |
| New Mexico | $262.67 | $111.06 |
| New Orleans | $265.67 | $110.09 |
| North Carolina | $253.41 | $99.15 |
| North Dakota** | $260.66 | $95.32 |
| Northern Nj | $308.72 | $116.93 |
| Nyc Suburbs/Long Island | $331.24 | $134.66 |
| Ohio | $257.74 | $106.79 |
| Oklahoma | $249.06 | $101.41 |
| Oxnard-Thousand Oaks-Ventura | $300.71 | $105.29 |
| Portland | $289.48 | $105.79 |
| Poughkpsie/N Nyc Suburbs | $298.63 | $117.59 |
| Puerto Rico | $275.25 | $108.10 |
| Queens | $320.94 | $125.52 |
| Redding | $282.27 | $101.07 |
| Rest Of California | $282.27 | $101.07 |
| Rest Of Florida | $276.39 | $118.33 |
| Rest Of Georgia | $257.88 | $110.40 |
| Rest Of Illinois | $269.79 | $118.84 |
| Rest Of Louisiana | $251.52 | $105.19 |
| Rest Of Maine | $250.65 | $98.54 |
| Rest Of Maryland | $274.66 | $107.34 |
| Rest Of Massachusetts | $279.97 | $105.88 |
| Rest Of Michigan | $260.37 | $109.42 |
| Rest Of Missouri | $247.64 | $105.12 |
| Rest Of New Jersey | $295.29 | $114.74 |
| Rest Of New York | $257.92 | $100.85 |
| Rest Of Oregon | $266.37 | $101.70 |
| Rest Of Pennsylvania | $257.30 | $105.52 |
| Rest Of Texas | $262.08 | $105.18 |
| Rest Of Washington | $278.99 | $104.89 |
| Rhode Island | $278.57 | $107.78 |
| Riverside-San Bernardino-Ontario | $289.22 | $108.02 |
| Sacramento-Roseville-Folsom | $295.88 | $103.59 |
| Salinas | $294.80 | $103.18 |
| San Diego-Chula Vista-Carlsbad | $301.66 | $103.92 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $343.60 | $110.48 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $342.86 | $109.74 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $352.17 | $113.76 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $349.15 | $110.74 |
| San Luis Obispo-Paso Robles | $290.17 | $101.86 |
| Santa Cruz-Watsonville | $304.41 | $103.53 |
| Santa Maria-Santa Barbara | $295.88 | $103.10 |
| Santa Rosa-Petaluma | $307.41 | $104.38 |
| Seattle (King Cnty) | $314.69 | $111.82 |
| South Carolina | $256.34 | $103.57 |
| South Dakota** | $259.14 | $93.80 |
| Southern Maine | $263.89 | $100.04 |
| Stockton | $282.27 | $101.07 |
| Suburban Chicago | $295.75 | $125.95 |
| Tennessee | $246.78 | $96.50 |
| Utah | $260.32 | $104.90 |
| Vallejo | $324.52 | $106.61 |
| Vermont | $260.99 | $97.31 |
| Virgin Islands | $275.25 | $108.10 |
| Virginia | $264.05 | $101.52 |
| Visalia | $282.27 | $101.07 |
| West Virginia | $258.85 | $115.17 |
| Wisconsin | $250.81 | $92.42 |
| Wyoming** | $267.91 | $102.57 |
| Yuba City | $282.27 | $101.07 |
36227 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.
$237.12
$317.22
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 | $309.82 | 1 |
| AL | $241.17 | 1 |
| AR | $237.12 | 1 |
| AZ | $264.73 | 1 |
| CA | $282.27–$352.17 | 29 |
| CO | $281.37 | 1 |
| CT | $293.62 | 1 |
| DC | $312.39 | 1 |
| DE | $269.50 | 1 |
| FL | $276.39–$314.28 | 3 |
| GA | $257.88–$281.06 | 2 |
| GU | $289.58 | 1 |
| HI | $289.58 | 1 |
| IA | $244.85 | 1 |
| ID | $247.42 | 1 |
| IL | $269.79–$303.06 | 4 |
| IN | $248.98 | 1 |
| KS | $245.15 | 1 |
| KY | $251.32 | 1 |
| LA | $251.52–$265.67 | 2 |
| MA | $279.97–$309.60 | 2 |
| MD | $274.66–$312.39 | 3 |
| ME | $250.65–$263.89 | 2 |
| MI | $260.37–$282.02 | 2 |
| MN | $263.60 | 1 |
| MO | $247.64–$264.78 | 3 |
| MS | $242.35 | 1 |
| MT | $273.51 | 1 |
| NC | $253.41 | 1 |
| ND | $260.66 | 1 |
| NE | $245.90 | 1 |
| NH | $278.37 | 1 |
| NJ | $295.29–$308.72 | 2 |
| NM | $262.67 | 1 |
| NV | $270.11 | 1 |
| NY | $257.92–$331.24 | 5 |
| OH | $257.74 | 1 |
| OK | $249.06 | 1 |
| OR | $266.37–$289.48 | 2 |
| PA | $257.30–$286.50 | 2 |
| PR | $275.25 | 1 |
| RI | $278.57 | 1 |
| SC | $256.34 | 1 |
| SD | $259.14 | 1 |
| TN | $246.78 | 1 |
| TX | $255.48–$281.87 | 8 |
| UT | $260.32 | 1 |
| VA | $264.05–$312.39 | 2 |
| VI | $275.25 | 1 |
| VT | $260.99 | 1 |
| WA | $278.99–$314.69 | 2 |
| WI | $250.81 | 1 |
| WV | $258.85 | 1 |
| WY | $267.91 | 1 |
How the 36227 rate is calculated
Each of 36227’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 · 36227
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.04Practice expense 5.50Malpractice 0.65
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 36227
The CMS indicators that decide how 36227 is paid alongside other services.
CMS payment indicators · 36227
External carotid angiography
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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
36227 without 50 · national office
$273.55
External carotid angiography
36227-50 · Bilateral: 150%
$410.33
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).
36227 compared with similar codes
Compare codes
36227 vs 36222 vs 36224 vs 36228 vs 36226: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 36222Carotid angiography
- 36222 covers selective catheterization of the common carotid or innominate artery and angiography of the associated carotid circulation. Choose 36227 for the separately performed external carotid selective study.
- 36224Carotid angiography
- 36224 is for selective internal carotid catheterization and angiography; 36227 is for the external carotid circulation.
- 36228Intracranial catheterization
- 36228 concerns selective catheter placement in an intracranial artery branch. 36227 addresses the external carotid artery and its circulation.
- 36226Vertebral angiography
- 36226 describes selective vertebral artery catheterization and angiography, not external carotid catheterization.
36227 billing questions
Can 36227 be reported by itself?
No. It is an add-on code and must be reported with an eligible primary cervicocerebral angiography procedure.
How is 36227 different from 36224?
36227 describes selective catheter placement and angiography of the external carotid circulation. 36224 concerns selective placement in the internal carotid artery and angiography of its circulation.
Does 36227 include the angiographic imaging?
Yes. Angiography of the external carotid circulation is part of the service, including intracranial imaging when performed.
How should bilateral external carotid studies be reported?
For a bilateral procedure, use modifier 50 as applicable. CMS pays 150% for the bilateral procedure under the supplied rule.
What documentation supports reporting 36227?
Document the external carotid artery selectively catheterized, the angiography performed, and the clinical reason and findings for the study.
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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