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Billing code 36450: Exchange transfusionMedicare rate & RVUs

Reports a newborn blood exchange that progressively removes circulating blood and replaces it with donor blood, commonly for severe neonatal hyperbilirubinemia.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $143.96 for 36450 nationally in a facility.

Medicare rate · 36450

Exchange transfusion

Swap in your local Medicare rate.

Work RVUs
3.41
Total RVUs
4.31
Global days
XXX

National rate · 2026

$143.96

Facility setting, before claim adjustments.

See every locality for 36450 → · 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
  1. Medicare rate
  2. What 36450 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 36450 covers

This service replaces a newborn’s circulating blood through a controlled process of withdrawing blood and infusing compatible donor blood. It is typically performed by a neonatologist or pediatrician in a hospital nursery or NICU. A common clinical situation is severe hyperbilirubinemia associated with hemolytic disease of the newborn. Vascular access may use an umbilical catheter, and the exchange is carried out in measured portions rather than as a routine transfusion.

Report 36450 for a newborn exchange, not for a simple transfusion or a partial exchange. Documentation should establish the newborn’s status, the clinical reason for the exchange, and that blood was removed and replaced as an exchange procedure. When multiple procedures subject to the standard multiple procedure reduction are performed in the same session, the highest-valued procedure is paid in full and the others are paid 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 36450 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

36450 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$138.03
Alaska*Unavailable$199.26
ArizonaUnavailable$142.23
ArkansasUnavailable$137.31
AtlantaUnavailable$146.08
AustinUnavailable$144.72
BakersfieldUnavailable$145.59
Baltimore/Surr. CntysUnavailable$149.12
BeaumontUnavailable$141.39
BrazoriaUnavailable$143.12

36450 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.

View every state and territory as a table
36450 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 36450 rate is calculated

Each of 36450’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 · 36450

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 3.41Practice expense 0.69Malpractice 0.21

4.3100 adjusted RVUs×$33.4009 conversion factor=$143.96

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 36450

The CMS indicators that decide how 36450 is paid alongside other services.

CMS payment indicators · 36450

Exchange transfusion

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
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)0Not paid without supporting documentation.
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

36450 without 51 · national facility

$143.96

Exchange transfusion

36450-51 · Second procedure: 50%

$71.98

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

36450 compared with similar codes

Compare codes

36450 vs 36455 vs 36456 vs 36430 vs 36440: national Medicare rates

Swap in your local Medicare rate.

  • 36450
    Exchange transfusion · 3.41 wRVU
    —
  • 36455
    Exchange transfusion · 2.37 wRVU
    —
  • 36456
    Blood exchange · 1.95 wRVU
    —
  • 36430
    Blood transfusion · 0 wRVU
    $47.43
  • 36440
    Blood transfusion · 1 wRVU
    —

How to choose

36455Exchange transfusion
Both describe exchange transfusion, but 36455 is for patients other than newborns; 36450 is the newborn code.
36456Blood exchange
Use 36456 for a partial exchange in a newborn. Use 36450 when the documented service is a newborn exchange transfusion.
36430Blood transfusion
36430 describes transfusion of blood or blood components. It does not describe the removal-and-replacement process of an exchange.
36440Blood transfusion
36440 describes a push transfusion for a young child, not a newborn blood exchange.

Codes related to 36450

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 36450
CodeHow it relatesNational office range
Same family
36455Exchange transfusionExchange transfusion code for patients other than newborns.No office rate
36456Blood exchangeNewborn partial exchange rather than a newborn exchange transfusion.No office rate
Used instead
36430Blood transfusionFor a transfusion service, rather than blood removal and replacement as an exchange.$40.40–$67.49

36450 billing questions

How does 36450 differ from 36456?

36450 represents a newborn exchange transfusion; 36456 is for a partial exchange in a newborn. The record should support which type of exchange was performed.

Can 36450 be used for a routine newborn transfusion?

No. Use 36450 when blood is withdrawn and replaced as an exchange; a transfusion that simply administers blood is a different service.

Should 36430 also be reported for the donor blood used in the exchange?

Do not separately report 36430 for blood administration that is part of the same exchange service. Consider it only for a distinct transfusion service supported by the record.

What documentation supports reporting 36450?

Document the newborn’s clinical indication and the exchange procedure, including that blood was removed and replaced. A routine transfusion record alone does not establish an exchange.

How does the multiple procedure reduction affect payment?

When multiple procedures subject to the standard reduction are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.

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 36450PPRRVU2026_Oct_nonQPP.csv, line 4,477 (RVU26D)

Open CMS sourceHow we calculate rates

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