Billing code 36406: Pediatric venipunctureMedicare rate & RVUs
Physician- or qualified-practitioner venipuncture from a non-scalp, non-femoral or jugular vein in a child younger than three when skilled access is required.
Medicare pays $18.37 for 36406 nationally in the office and $7.68 in a hospital or facility. Local office rates run $16.51–$24.19.
Medicare rate · 36406
Pediatric venipuncture
Swap in your local Medicare rate.
- Work RVUs
- 0.18
- Total RVUs
- 0.55
- Global days
- XXX
National rate · 2026
$18.37
Office setting, before claim adjustments.
See every locality for 36406 → · 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 36406 covers
This service is a venous puncture in a child younger than three that requires a physician’s or qualified health care professional’s skill. It covers access through a vein other than the scalp, femoral, or jugular sites represented by neighboring codes. Examples of other sites include peripheral veins in the hand, foot, or arm. It may be performed in a hospital, clinic, or other setting where the child needs a venous specimen or venous access for a clinical purpose.
Report the code for the skilled puncture, not for the laboratory test performed on the specimen. Documentation should identify the child’s age, the vein accessed, the clinical purpose, and the circumstances supporting the need for physician or qualified-practitioner skill. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction.
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 36406 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
$16.51 to $24.19
109 of 109 payment localities
36406 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$16.51
$22.01
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 | $22.01 | 1 |
| AL | $16.72 | 1 |
| AR | $16.51 | 1 |
| AZ | $17.95 | 1 |
| CA | $19.47–$24.19 | 29 |
| CO | $19.14 | 1 |
| CT | $19.49 | 1 |
| DC | $20.87 | 1 |
| DE | $18.22 | 1 |
| FL | $18.01–$19.37 | 3 |
| GA | $17.14–$18.65 | 2 |
| GU | $19.88 | 1 |
| HI | $19.88 | 1 |
| IA | $17.15 | 1 |
| ID | $17.23 | 1 |
| IL | $17.51–$19.00 | 4 |
| IN | $17.32 | 1 |
| KS | $17.05 | 1 |
| KY | $17.01 | 1 |
| LA | $16.97–$17.71 | 2 |
| MA | $19.04–$20.91 | 2 |
| MD | $18.55–$20.87 | 3 |
| ME | $17.28–$18.14 | 2 |
| MI | $17.37–$18.18 | 2 |
| MN | $18.48 | 1 |
| MO | $16.70–$17.79 | 3 |
| MS | $16.61 | 1 |
| MT | $18.37 | 1 |
| NC | $17.44 | 1 |
| ND | $18.17 | 1 |
| NE | $17.24 | 1 |
| NH | $18.82 | 1 |
| NJ | $19.75–$20.70 | 2 |
| NM | $17.44 | 1 |
| NV | $18.33 | 1 |
| NY | $17.67–$21.31 | 5 |
| OH | $17.33 | 1 |
| OK | $17.01 | 1 |
| OR | $18.22–$19.72 | 2 |
| PA | $17.37–$19.04 | 2 |
| PR | $18.50 | 1 |
| RI | $18.85 | 1 |
| SC | $17.41 | 1 |
| SD | $18.15 | 1 |
| TN | $17.12 | 1 |
| TX | $17.26–$19.04 | 8 |
| UT | $17.61 | 1 |
| VA | $18.07–$20.87 | 2 |
| VI | $18.50 | 1 |
| VT | $18.09 | 1 |
| WA | $19.01–$21.34 | 2 |
| WI | $17.63 | 1 |
| WV | $16.94 | 1 |
| WY | $18.28 | 1 |
How the 36406 rate is calculated
Each of 36406’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 · 36406
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.18Practice expense 0.36Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 36406
The CMS indicators that decide how 36406 is paid alongside other services.
CMS payment indicators · 36406
Pediatric 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
36406 without 51 · national office
$18.37
Pediatric venipuncture
36406-51 · Second procedure: 50%
$9.19
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%).
36406 compared with similar codes
Compare codes
36406 vs 36400 vs 36405 vs 36410 vs 36415: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 36400Venipuncture
- Use 36400 for femoral or jugular access in a child younger than three. This code is for another vein.
- 36405Scalp venipuncture
- Use 36405 for scalp-vein access in a child younger than three. This code covers other venous sites.
- 36410Skilled venipuncture
- Use 36410 for skilled venipuncture in a patient age three or older; this code is for children younger than three.
- 36415Coll venous bld venipuncture
- Code 36415 represents routine venous blood collection. This code represents a pediatric puncture requiring physician or qualified-practitioner skill.
36406 billing questions
How does this code differ from 36405 and 36400?
This code is for a vein other than the scalp, femoral, or jugular vein. Code 36405 is for scalp access, while 36400 is for femoral or jugular access in a child younger than three.
When is 36410 used instead?
Code 36410 is the related venipuncture code for a patient age three or older when physician or qualified-practitioner skill is required.
Does this code include laboratory testing?
No. It represents the skilled venipuncture; the laboratory analysis is a separate service.
Can routine staff-performed blood collection be reported with this code?
The code describes venipuncture requiring physician or qualified-practitioner skill. A routine collection without that skilled service does not fit this code.
How does the multiple-procedure reduction affect payment?
For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are paid at 50% under the standard multiple-procedure reduction.
What should the record show?
Document the child’s age, the access site, the clinical purpose, and why the puncture required physician or qualified-practitioner skill.
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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