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Billing code 37607: Access fistula procedureMedicare rate & RVUs

Reports surgical closure or flow reduction of an existing dialysis-access arteriovenous fistula, commonly for access-related hand ischemia or excessive shunting.

CMS RVU26DEffective Oct 1, 2026109 payment localities6.9K Medicare services in 2024

Medicare pays $346.03 for 37607 nationally in a facility.

Medicare rate · 37607

Access fistula procedure

Work RVUs
6.09
Total RVUs
10.36
Global days
090

National rate · 2026

$346.03

Facility setting, before claim adjustments.

See every locality for 37607 →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 37607 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 37607 covers

A vascular surgeon ligates an existing arteriovenous access fistula to stop its flow or places a band to reduce flow while preserving access. Typical situations include access-related hand ischemia or excessive shunting that contributes to cardiac strain. The service is performed in an operative setting; the operative note should identify the access and explain whether it was closed or flow-reduced and why intervention was needed.

This is a major surgery with a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery; 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 37607 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

37607 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$312.93
Alaska*Unavailable$431.60
ArizonaUnavailable$336.03
ArkansasUnavailable$308.92
AtlantaUnavailable$358.07
AustinUnavailable$346.21
BakersfieldUnavailable$339.52
Baltimore/Surr. CntysUnavailable$367.81
BeaumontUnavailable$334.14
BrazoriaUnavailable$335.95

37607 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
37607 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 37607 rate is calculated

Each of 37607’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 · 37607

RVUs × geographic indexes × conversion factor

Work6.09

6.09 RVUs× 1.000 GPCI

Practice expense2.79

2.79 RVUs× 1.000 GPCI

Malpractice1.48

1.48 RVUs× 1.000 GPCI

Adjusted RVUs

10.3600

Conversion factor

$33.4009

Medicare rate

$346.03

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 37607

37607 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 37607

Access fistula procedure

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are 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)1Not paid (statutory restriction).
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.84/0.07Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 37607

Access fistula procedure

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

37607 without 51 · national facility

$346.03

Access fistula procedure

37607-51 · Second procedure: 50%

$173.02

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

37607 compared with similar codes

Compare codes · National

4 codes, side by side

  • 37607

    Access fistula procedure6.09 wRVU

    Not priced

  • 36821

    Dialysis access11.6 wRVU

    Not priced

  • 36832

    Fistula revision13.16 wRVU

    Not priced

  • 36833

    Fistula revision14.14 wRVU

    Not priced

How to choose

36821Dialysis access
36821 establishes a direct arteriovenous access. Use 37607 for an existing access that is being closed or have its flow reduced.
36832Fistula revision
36832 describes revision of an existing fistula. Choose 37607 when the documented procedure instead ligates the access or reduces its flow by banding.
36833Fistula revision
36833 is for fistula revision with thrombectomy. It is distinct from 37607, which addresses closure or flow reduction rather than clot removal with revision.

Codes related to 37607

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

Codes related to 37607
CodeHow it relatesNational office range
Used instead
36821Dialysis accessCreates a direct arteriovenous access rather than closing or reducing flow in an existing fistula.No office rate
36832Fistula revisionRevises an existing fistula when the operative goal is access revision rather than ligation or banding.No office rate
36833Fistula revisionRevises an existing fistula with thrombectomy when clot removal accompanies the revision.No office rate

37607 billing questions

When should this code be chosen over an access revision code?

Use 37607 when the operative goal is to close the existing fistula or reduce its flow with banding. A revision code describes a different operation intended to revise or salvage the access.

Can modifier 50 be used when a patient has access fistulas on both sides?

No. The CMS facts specify that bilateral adjustment does not apply and modifier 50 is inappropriate for this service.

What documentation supports reporting 37607?

Document the fistula treated, the clinical reason for intervention, and the operative method and result, such as closure or flow reduction by banding.

How does the 90-day global period affect postoperative billing?

The day-before preoperative visit and related postoperative care for 90 days are included in the global period. The period begins with the surgery.

How are other procedures in the same session paid?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are reduced when performed in the same session.

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery, and team surgery is not permitted. Co-surgeons are paid only when supporting documentation is provided.

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 37607PPRRVU2026_Oct_nonQPP.csv, line 4,675 (RVU26D)

Open CMS sourceHow we calculate rates

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