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Billing code 36680: Intraosseous accessMedicare rate & RVUs

Reports placement of an intraosseous needle to establish access for infusion when urgent treatment requires access through the bone marrow cavity.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.9K Medicare services in 2024

Medicare pays $57.78 for 36680 nationally in a facility.

Medicare rate · 36680

Intraosseous access

Swap in your local Medicare rate.

Work RVUs
1.17
Total RVUs
1.73
Global days
000

National rate · 2026

$57.78

Facility setting, before claim adjustments.

See every locality for 36680 → · 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 36680 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 36680 covers

This service establishes intraosseous access by inserting a needle into a bone marrow cavity so fluids or medications can be delivered when urgent vascular access is needed. It is commonly performed by emergency physicians and other qualified clinicians in hospital emergency departments or other acute-care settings, such as when a patient in shock or cardiac arrest cannot be accessed promptly through a peripheral vein. The proximal tibia is a familiar access site; the actual bone and side should be documented.

Report the insertion, not each fluid or medication subsequently delivered through the access. The record should identify the clinical need, insertion site, and whether access was successfully established. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Do not use modifier 50 for this service. Assistant-at-surgery payment requires documented medical necessity; 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 36680 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

36680 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$53.07
Alaska*Unavailable$74.59
ArizonaUnavailable$56.34
ArkansasUnavailable$52.50
AtlantaUnavailable$59.62
AustinUnavailable$57.63
BakersfieldUnavailable$56.58
Baltimore/Surr. CntysUnavailable$61.03
BeaumontUnavailable$56.25
BrazoriaUnavailable$56.31

36680 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
36680 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 36680 rate is calculated

Each of 36680’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 · 36680

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 1.17Practice expense 0.33Malpractice 0.23

1.7300 adjusted RVUs×$33.4009 conversion factor=$57.78

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

Payment rules and modifiers for 36680

The CMS indicators that decide how 36680 is paid alongside other services.

CMS payment indicators · 36680

Intraosseous access

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
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

36680 without 51 · national facility

$57.78

Intraosseous access

36680-51 · Second procedure: 50%

$28.89

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

36680 compared with similar codes

Compare codes

36680 vs 36000 vs 36555 vs 36556 vs 36620: national Medicare rates

Swap in your local Medicare rate.

  • 36680
    Intraosseous access · 1.17 wRVU
    —
  • 36000
    · 0.18 wRVU
    —
  • 36555
    Central line insertion · 1.88 wRVU
    $213.43
  • 36556
    Central line insertion · 1.71 wRVU
    $237.81
  • 36620
    Arterial catheter · 0.98 wRVU
    —

How to choose

36000Place needle in vein
Use 36680 when the access needle enters a bone marrow cavity; 36000 describes introduction of a needle or catheter into a vein.
36555Central line insertion
36555 is for centrally inserted, non-tunneled central venous catheter placement in a patient younger than five, not intraosseous access.
36556Central line insertion
36556 is for centrally inserted, non-tunneled central venous catheter placement in a patient age five or older; 36680 accesses the marrow cavity.
36620Arterial catheter
36620 describes arterial catheter placement, commonly for arterial monitoring or sampling. It does not establish intraosseous infusion access.

Codes related to 36680

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

Codes related to 36680
CodeHow it relatesNational office range
Used instead
36000Place needle in veinPeripheral venous access uses a vein rather than the bone marrow cavity.No office rate
36555Central line insertionCentral venous catheter placement is another access approach for patients younger than five.$190.35–$282.08
36556Central line insertionCentral venous catheter placement is another access approach for patients age five or older.$209.69–$317.01
Often billed with
99291Critical careMay be reported for a separately supported critical-care service during the same emergency encounter.$281.30–$386.53

36680 billing questions

When should I report 36680 instead of peripheral IV access?

Report 36680 for needle placement into a bone marrow cavity to establish infusion access, commonly in an urgent situation when peripheral venous access is unavailable or inadequate. Ordinary access through a peripheral vein is not intraosseous placement.

Can the fluids or medications infused through the needle be reported as additional units of 36680?

No. The code reports insertion of the intraosseous needle, not each fluid or medication delivered through the established access.

What should the documentation identify?

Document the clinical reason for intraosseous access, the bone and side used, and whether placement successfully established access.

Should modifier 50 be appended for access on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this descriptor and anatomy.

How does the multiple-procedure reduction affect 36680?

For procedures performed in the same session, CMS pays the highest-valued procedure in full and subjects the other procedures to the standard 50% reduction.

Can an assistant surgeon or co-surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.

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 36680PPRRVU2026_Oct_nonQPP.csv, line 4,542 (RVU26D)

Open CMS sourceHow we calculate rates

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