Billing code 36904: Dialysis thrombectomyMedicare rate & RVUs
Percutaneous clot removal or thrombolytic treatment restores flow through a thrombosed hemodialysis fistula or graft when the dialysis circuit requires endovascular salvage.
Medicare pays $1,740.85 for 36904 nationally in the office and $320.65 in a hospital or facility. Local office rates run $1,516.84–$2,395.06.
Medicare rate · 36904
Dialysis thrombectomy
Swap in your local Medicare rate.
- Work RVUs
- 7.31
- Total RVUs
- 52.12
- Global days
- 000
National rate · 2026
$1,740.85
Office setting, before claim adjustments.
See every locality for 36904 → · 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 36904 covers
This service treats clot obstructing a hemodialysis access circuit, such as an arteriovenous fistula or graft, by mechanically removing clot, infusing thrombolytic medication, or using both approaches. An interventional radiologist, vascular surgeon, or appropriately trained nephrologist typically performs the intervention in an angiography suite or hospital procedure room. Access, catheter placement, and imaging used to guide and assess the circuit intervention are included in the service.
Choose 36904 when thrombectomy or thrombolysis is performed without peripheral-segment angioplasty or stent placement; those additional treatments change the code selection. Document the access circuit treated, the clot and intervention performed, and any additional treatment of peripheral or central segments. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this dialysis-circuit service. Medicare does not pay an assistant at surgery under the stated statutory restriction; co-surgeon payment requires supporting documentation, and team surgery is 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 36904 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
$1516.84 to $2395.06
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $1,542.11 | $299.43 |
| Alaska* | $1,940.82 | $428.30 |
| Arizona | $1,690.19 | $314.01 |
| Arkansas | $1,516.84 | $296.88 |
| Atlanta | $1,772.52 | $329.59 |
| Austin | $1,821.66 | $319.08 |
| Bakersfield | $1,870.80 | $314.25 |
| Baltimore/Surr. Cntys | $1,860.21 | $336.33 |
| Beaumont | $1,606.87 | $314.48 |
| Brazoria | $1,721.37 | $313.95 |
| Chicago | $1,798.74 | $371.43 |
| Chico | $1,867.55 | $311.01 |
| Colorado | $1,828.89 | $317.79 |
| Connecticut | $1,866.00 | $336.44 |
| Dallas | $1,731.86 | $317.33 |
| Dc + Md/Va Suburbs | $2,018.00 | $344.99 |
| Delaware | $1,720.76 | $317.59 |
| Detroit | $1,715.68 | $345.18 |
| East St. Louis | $1,662.41 | $355.82 |
| El Centro | $1,867.74 | $311.19 |
| Fort Lauderdale | $1,790.32 | $351.65 |
| Fort Worth | $1,717.76 | $317.43 |
| Fresno | $1,867.55 | $311.01 |
| Galveston | $1,726.10 | $315.84 |
| Hanford-Corcoran | $1,867.55 | $311.01 |
| Hawaii, Guam | $1,924.84 | $310.07 |
| Houston | $1,746.79 | $336.52 |
| Idaho | $1,604.25 | $297.66 |
| Indiana | $1,614.95 | $298.42 |
| Iowa | $1,594.09 | $294.60 |
| Kansas | $1,582.08 | $298.21 |
| Kentucky | $1,575.70 | $313.14 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $2,005.17 | $325.07 |
| Madera | $1,867.55 | $311.01 |
| Manhattan | $2,014.95 | $364.67 |
| Merced | $1,867.55 | $311.01 |
| Metropolitan Boston | $2,029.75 | $334.02 |
| Metropolitan Kansas City | $1,650.99 | $317.42 |
| Metropolitan Philadelphia | $1,812.35 | $333.92 |
| Metropolitan St. Louis | $1,670.90 | $318.86 |
| Miami | $1,858.38 | $379.95 |
| Minnesota | $1,756.59 | $295.20 |
| Mississippi | $1,528.21 | $305.41 |
| Modesto | $1,867.55 | $311.01 |
| Montana** | $1,740.78 | $320.57 |
| Napa | $2,201.61 | $329.78 |
| Nebraska | $1,605.04 | $294.19 |
| Nevada** | $1,736.01 | $314.38 |
| New Hampshire | $1,795.95 | $317.52 |
| New Mexico | $1,627.35 | $325.02 |
| New Orleans | $1,659.91 | $323.50 |
| North Carolina | $1,629.48 | $304.43 |
| North Dakota** | $1,718.44 | $298.23 |
| Northern Nj | $1,992.24 | $344.80 |
| Nyc Suburbs/Long Island | $2,064.57 | $375.94 |
| Ohio | $1,614.23 | $317.58 |
| Oklahoma | $1,576.33 | $308.09 |
| Oxnard-Thousand Oaks-Ventura | $1,998.99 | $320.31 |
| Portland | $1,897.04 | $319.19 |
| Poughkpsie/N Nyc Suburbs | $1,898.37 | $343.24 |
| Puerto Rico | $1,756.34 | $320.51 |
| Queens | $2,038.69 | $360.01 |
| Redding | $1,867.55 | $311.01 |
| Rest Of California | $1,867.55 | $311.01 |
| Rest Of Florida | $1,695.65 | $337.93 |
| Rest Of Georgia | $1,590.53 | $323.71 |
| Rest Of Illinois | $1,635.18 | $338.53 |
| Rest Of Louisiana | $1,571.49 | $314.61 |
| Rest Of Maine | $1,609.87 | $303.28 |
| Rest Of Maryland | $1,757.71 | $320.46 |
| Rest Of Massachusetts | $1,814.42 | $318.95 |
| Rest Of Michigan | $1,618.79 | $322.15 |
| Rest Of Missouri | $1,538.54 | $314.32 |
| Rest Of New Jersey | $1,888.51 | $337.64 |
| Rest Of New York | $1,656.70 | $307.50 |
| Rest Of Oregon | $1,723.81 | $309.28 |
| Rest Of Pennsylvania | $1,619.15 | $315.40 |
| Rest Of Texas | $1,662.79 | $315.01 |
| Rest Of Washington | $1,812.33 | $316.86 |
| Rhode Island | $1,789.56 | $322.49 |
| Riverside-San Bernardino-Ontario | $1,879.76 | $323.21 |
| Sacramento-Roseville-Folsom | $1,969.94 | $318.24 |
| Salinas | $1,962.88 | $316.87 |
| San Diego-Chula Vista-Carlsbad | $2,016.85 | $318.28 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $2,341.80 | $339.31 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $2,340.52 | $338.03 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $2,395.06 | $347.12 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $2,389.81 | $341.87 |
| San Luis Obispo-Paso Robles | $1,930.29 | $312.67 |
| Santa Cruz-Watsonville | $2,042.14 | $316.59 |
| Santa Maria-Santa Barbara | $1,972.36 | $316.40 |
| Santa Rosa-Petaluma | $2,063.31 | $319.29 |
| Seattle (King Cnty) | $2,077.34 | $334.74 |
| South Carolina | $1,624.31 | $312.04 |
| South Dakota** | $1,715.79 | $295.59 |
| Southern Maine | $1,713.80 | $306.37 |
| Stockton | $1,867.55 | $311.01 |
| Suburban Chicago | $1,811.09 | $352.54 |
| Tennessee | $1,590.62 | $299.65 |
| Utah | $1,649.47 | $314.47 |
| Vallejo | $2,199.76 | $327.93 |
| Vermont | $1,707.62 | $301.62 |
| Virgin Islands | $1,756.34 | $320.51 |
| Virginia | $1,704.96 | $308.89 |
| Visalia | $1,867.55 | $311.01 |
| West Virginia | $1,566.00 | $331.84 |
| Wisconsin | $1,653.46 | $292.90 |
| Wyoming** | $1,731.04 | $310.84 |
| Yuba City | $1,867.55 | $311.01 |
36904 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.
$1,516.84
$2,131.31
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 | $1,940.82 | 1 |
| AL | $1,542.11 | 1 |
| AR | $1,516.84 | 1 |
| AZ | $1,690.19 | 1 |
| CA | $1,867.55–$2,395.06 | 29 |
| CO | $1,828.89 | 1 |
| CT | $1,866.00 | 1 |
| DC | $2,018.00 | 1 |
| DE | $1,720.76 | 1 |
| FL | $1,695.65–$1,858.38 | 3 |
| GA | $1,590.53–$1,772.52 | 2 |
| GU | $1,924.84 | 1 |
| HI | $1,924.84 | 1 |
| IA | $1,594.09 | 1 |
| ID | $1,604.25 | 1 |
| IL | $1,635.18–$1,811.09 | 4 |
| IN | $1,614.95 | 1 |
| KS | $1,582.08 | 1 |
| KY | $1,575.70 | 1 |
| LA | $1,571.49–$1,659.91 | 2 |
| MA | $1,814.42–$2,029.75 | 2 |
| MD | $1,757.71–$2,018.00 | 3 |
| ME | $1,609.87–$1,713.80 | 2 |
| MI | $1,618.79–$1,715.68 | 2 |
| MN | $1,756.59 | 1 |
| MO | $1,538.54–$1,670.90 | 3 |
| MS | $1,528.21 | 1 |
| MT | $1,740.78 | 1 |
| NC | $1,629.48 | 1 |
| ND | $1,718.44 | 1 |
| NE | $1,605.04 | 1 |
| NH | $1,795.95 | 1 |
| NJ | $1,888.51–$1,992.24 | 2 |
| NM | $1,627.35 | 1 |
| NV | $1,736.01 | 1 |
| NY | $1,656.70–$2,064.57 | 5 |
| OH | $1,614.23 | 1 |
| OK | $1,576.33 | 1 |
| OR | $1,723.81–$1,897.04 | 2 |
| PA | $1,619.15–$1,812.35 | 2 |
| PR | $1,756.34 | 1 |
| RI | $1,789.56 | 1 |
| SC | $1,624.31 | 1 |
| SD | $1,715.79 | 1 |
| TN | $1,590.62 | 1 |
| TX | $1,606.87–$1,821.66 | 8 |
| UT | $1,649.47 | 1 |
| VA | $1,704.96–$2,018.00 | 2 |
| VI | $1,756.34 | 1 |
| VT | $1,707.62 | 1 |
| WA | $1,812.33–$2,077.34 | 2 |
| WI | $1,653.46 | 1 |
| WV | $1,566.00 | 1 |
| WY | $1,731.04 | 1 |
How the 36904 rate is calculated
Each of 36904’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 · 36904
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.31Practice expense 43.68Malpractice 1.13
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 36904
The CMS indicators that decide how 36904 is paid alongside other services.
CMS payment indicators · 36904
Dialysis thrombectomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| 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) | 1 | Permitted with supporting documentation. |
| 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
36904 without 51 · national office
$1,740.85
Dialysis thrombectomy
36904-51 · Second procedure: 50%
$870.43
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%).
36904 compared with similar codes
Compare codes
36904 vs 36901 vs 36902 vs 36905 vs 36906: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 36901Circuit angiography
- 36901 covers dialysis-circuit catheterization and imaging without thrombectomy or thrombolysis. Choose 36904 when clot removal or thrombolytic infusion is performed.
- 36902Dialysis access angioplasty
- 36902 includes peripheral-segment angioplasty without the thrombectomy or thrombolysis represented by 36904. Select based on the intervention actually performed.
- 36905Dialysis thrombectomy
- 36905 represents thrombectomy or thrombolysis with peripheral-segment angioplasty; 36904 is used when that peripheral angioplasty is not performed.
- 36906Dialysis access intervention
- 36906 represents thrombectomy or thrombolysis with peripheral-segment stent placement; 36904 is used when that peripheral stenting is not performed.
36904 billing questions
When should 36904 be selected instead of 36905 or 36906?
Use 36904 for thrombectomy or thrombolysis without peripheral-segment angioplasty or stent placement. Peripheral angioplasty or stenting changes the code selection to 36905 or 36906, respectively.
Are access, catheter placement, and circuit imaging separately reported?
Access, catheter placement, and imaging integral to the thrombectomy or thrombolysis are included in 36904. Do not separately report those included components as additional services.
Can 36907 or 36908 be reported with 36904?
Yes, when a separate central dialysis segment is treated with angioplasty or stent placement, the applicable central-segment add-on code may be reported with 36904.
Is modifier 50 appropriate for treatment of both sides?
No. Modifier 50 is inappropriate for this dialysis-circuit service; report the code for the circuit intervention performed.
What documentation supports 36904?
Document the thrombosed access circuit, the mechanical thrombectomy or thrombolytic infusion performed, and any additional peripheral or central segment treatment.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure's 0-day global period.
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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