CPT 36405: Scalp venipunctureMedicare rate & RVUs
Reports physician- or qualified health professional-performed scalp-vein venipuncture in a child younger than 3 years for specimen collection or therapeutic purposes.
Medicare pays $24.05 for 36405 nationally in the office and $12.69 in a hospital or facility. Local office rates run $21.84–$30.75.
Medicare rate · 36405
Scalp venipuncture
Swap in your local Medicare rate.
- Work RVUs
- 0.3
- Total RVUs
- 0.72
- Global days
- XXX
National rate · 2026
$24.05
Office setting, before claim adjustments.
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 36405 covers
This code represents venipuncture using a scalp vein in a child younger than 3 years when the procedure requires a physician’s or qualified health professional’s skill. It may be performed to obtain a blood specimen or for a therapeutic purpose, such as gaining venous access to administer treatment. The age and access site distinguish this service from other pediatric venipuncture codes.
Report the service when the documented procedure uses a scalp vein and the child is younger than 3 years; the record should support the site, age, and purpose. This code describes the venipuncture, not laboratory analysis of the specimen. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and the others at 50%.
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 36405 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
$21.84 to $30.75
109 of 109 payment localities
36405 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.
$21.84
$29.63
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 | $29.63 | 1 |
| AL | $22.09 | 1 |
| AR | $21.84 | 1 |
| AZ | $23.54 | 1 |
| CA | $25.19–$30.75 | 29 |
| CO | $24.88 | 1 |
| CT | $25.42 | 1 |
| DC | $27.04 | 1 |
| DE | $23.87 | 1 |
| FL | $23.80–$25.62 | 3 |
| GA | $22.73–$24.43 | 2 |
| GU | $25.60 | 1 |
| HI | $25.60 | 1 |
| IA | $22.51 | 1 |
| ID | $22.63 | 1 |
| IL | $23.26–$25.05 | 4 |
| IN | $22.73 | 1 |
| KS | $22.43 | 1 |
| KY | $22.51 | 1 |
| LA | $22.48–$23.35 | 2 |
| MA | $24.78–$26.98 | 2 |
| MD | $24.25–$27.04 | 3 |
| ME | $22.73–$23.68 | 2 |
| MI | $22.97–$24.04 | 2 |
| MN | $23.97 | 1 |
| MO | $22.19–$23.41 | 3 |
| MS | $22.02 | 1 |
| MT | $24.05 | 1 |
| NC | $22.91 | 1 |
| ND | $23.65 | 1 |
| NE | $22.60 | 1 |
| NH | $24.51 | 1 |
| NJ | $25.74–$26.86 | 2 |
| NM | $23.07 | 1 |
| NV | $23.95 | 1 |
| NY | $23.18–$27.79 | 5 |
| OH | $22.89 | 1 |
| OK | $22.47 | 1 |
| OR | $23.80–$25.52 | 2 |
| PA | $22.92–$24.91 | 2 |
| PR | $24.19 | 1 |
| RI | $24.61 | 1 |
| SC | $22.93 | 1 |
| SD | $23.61 | 1 |
| TN | $22.52 | 1 |
| TX | $22.80–$24.77 | 8 |
| UT | $23.18 | 1 |
| VA | $23.63–$27.04 | 2 |
| VI | $24.19 | 1 |
| VT | $23.59 | 1 |
| WA | $24.73–$27.46 | 2 |
| WI | $23.03 | 1 |
| WV | $22.59 | 1 |
| WY | $23.87 | 1 |
How the 36405 rate is calculated
Each of 36405’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 · 36405
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.30Practice expense 0.40Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 36405
The CMS indicators that decide how 36405 is paid alongside other services.
CMS payment indicators · 36405
Scalp venipuncture
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| 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
36405 without 51 · national office
$24.05
Scalp venipuncture
36405-51 · Second procedure: 50%
$12.03
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%).
36405 compared with similar codes
Compare codes
36405 vs 36400 vs 36406 vs 36410 vs 36420: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 36400Venipuncture
- Both describe skilled venipuncture in a child younger than 3 years, but 36400 identifies femoral or jugular access; 36405 identifies scalp access.
- 36406Pediatric venipuncture
- Use 36406 for a different vein not specified by the pediatric site-specific codes. Use 36405 when the accessed vein is in the scalp.
- 36410Skilled venipuncture
- 36410 is for physician- or qualified health professional-performed venipuncture in patients age 3 years or older; 36405 is for scalp access before age 3.
- 36420Venous cutdown
- 36420 describes venous access by cutdown in a child younger than 1 year. 36405 describes venipuncture through a scalp vein, not cutdown access.
36405 billing questions
When should 36405 be chosen over 36400 or 36406?
Choose 36405 for a scalp vein in a child younger than 3 years. Codes 36400 and 36406 distinguish other venous sites in this age group.
Can 36405 be reported for routine blood collection?
Use it when the documented scalp-vein access in a child younger than 3 requires physician or qualified health professional skill. Routine venous collection is represented by 36415.
Does 36405 include testing the blood specimen?
No. It represents the venipuncture; laboratory analysis is a separate service when performed and reportable.
How does Medicare handle 36405 with other procedures in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the others at 50%.
What documentation supports reporting 36405?
Document the child's age, scalp-vein access, and whether the venipuncture was for specimen collection or a therapeutic purpose.
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
Fee sheets
Put 36405 and the rest of your codes on one sheet
Current Medicare rates for every code you bill at your locality, with what changed since last quarter.
Get a fee sheetOr price your code list free →