No office rate
Choose 36818 for an upper-arm cephalic vein transposition; choose 36819 when the upper-arm basilic vein is used.
On this page
CMS RVU26D · Effective 2026-10-01
36818 in Modesto
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$600.03
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Vascular surgery
About 36818: Upper-arm cephalic vein fistula creation
Report this open operation to create hemodialysis access by transposing an upper-arm cephalic vein and connecting it to an artery.
A vascular surgeon creates an arteriovenous access for hemodialysis by mobilizing and transposing the cephalic vein in the upper arm, then connecting it to an artery. The transposed vein provides a superficial segment for later dialysis cannulation. This operation is generally performed in a hospital operating room for a patient who needs durable vascular access.
Select 36818 when the access is created using an upper-arm cephalic vein transposition; document the vessel, location, and operative steps. The service has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. 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% reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 36818
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU12.08 · 64%
- Practice expense (office) RVU3.69 · 20%
- Malpractice RVU3.05 · 16%
2.9K
Medicare services in 2024 · #2200 by national volume
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.
36818 compared with similar codes
Office rates for Modesto, from the same CMS release.
No office rate
36821 describes direct open artery-to-vein access creation. 36818 is specific to creating access with upper-arm cephalic vein transposition.
No office rate
36825 uses an autogenous graft to create access. 36818 uses the patient's transposed upper-arm cephalic vein.
The same code, a different location
How does Modesto compare?
36818 across payment areas
Same release and payment basis · bars start at $0
Modesto · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Madera
California · 36818
Office
Unavailable
Facility
$600.03
No comparable office rate is available.
Merced
California · 36818
Office
Unavailable
Facility
$600.03
No comparable office rate is available.
Napa
California · 36818
Office
Unavailable
Facility
$643.10
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 36818
Office
Unavailable
Facility
$623.93
No comparable office rate is available.
Redding
California · 36818
Office
Unavailable
Facility
$600.03
No comparable office rate is available.
Rest Of California
California · 36818
Office
Unavailable
Facility
$600.03
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 36818
Office
Unavailable
Facility
$632.72
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 36818
Office
Unavailable
Facility
$615.95
No comparable office rate is available.
Salinas
California · 36818
Office
Unavailable
Facility
$613.44
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 36818
Office
Unavailable
Facility
$618.21
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 36818
Office
Unavailable
Facility
$662.35
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 36818
Office
Unavailable
Facility
$658.89
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 36818
Office
Unavailable
Facility
$680.20
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 36818
Office
Unavailable
Facility
$666.03
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 36818
Office
Unavailable
Facility
$605.33
No comparable office rate is available.
Santa Cruz-Watsonville
California · 36818
Office
Unavailable
Facility
$616.31
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 36818
Office
Unavailable
Facility
$613.09
No comparable office rate is available.
Santa Rosa-Petaluma
California · 36818
Office
Unavailable
Facility
$621.54
No comparable office rate is available.
Stockton
California · 36818
Office
Unavailable
Facility
$600.03
No comparable office rate is available.
Vallejo
California · 36818
Office
Unavailable
Facility
$638.10
No comparable office rate is available.
Visalia
California · 36818
Office
Unavailable
Facility
$600.03
No comparable office rate is available.
Yuba City
California · 36818
Office
Unavailable
Facility
$600.03
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 36818
Office
Unavailable
Facility
$683.84
No comparable office rate is available.
Miami
Florida · 36818
Office
Unavailable
Facility
$789.42
No comparable office rate is available.
Chicago
Illinois · 36818
Office
Unavailable
Facility
$763.97
No comparable office rate is available.
Manhattan
New York · 36818
Office
Unavailable
Facility
$734.09
No comparable office rate is available.
Alaska*
Alaska · 36818
Office
Unavailable
Facility
$792.62
No comparable office rate is available.
Alabama
Alabama · 36818
Office
Unavailable
Facility
$568.99
No comparable office rate is available.
Arkansas
Arkansas · 36818
Office
Unavailable
Facility
$561.82
No comparable office rate is available.
Arizona
Arizona · 36818
Office
Unavailable
Facility
$610.11
No comparable office rate is available.
Colorado
Colorado · 36818
Office
Unavailable
Facility
$619.02
No comparable office rate is available.
Connecticut
Connecticut · 36818
Office
Unavailable
Facility
$667.56
No comparable office rate is available.
Delaware
Delaware · 36818
Office
Unavailable
Facility
$618.85
No comparable office rate is available.
Fort Lauderdale
Florida · 36818
Office
Unavailable
Facility
$712.52
No comparable office rate is available.
Rest Of Florida
Florida · 36818
Office
Unavailable
Facility
$674.42
No comparable office rate is available.
Atlanta
Georgia · 36818
Office
Unavailable
Facility
$652.26
No comparable office rate is available.
Rest Of Georgia
Georgia · 36818
Office
Unavailable
Facility
$634.85
No comparable office rate is available.
Hawaii, Guam
Hawaii · 36818
Office
Unavailable
Facility
$602.60
No comparable office rate is available.
Iowa
Iowa · 36818
Office
Unavailable
Facility
$556.70
No comparable office rate is available.
Idaho
Idaho · 36818
Office
Unavailable
Facility
$565.06
No comparable office rate is available.
East St. Louis
Illinois · 36818
Office
Unavailable
Facility
$722.04
No comparable office rate is available.
Rest Of Illinois
Illinois · 36818
Office
Unavailable
Facility
$675.24
No comparable office rate is available.
Suburban Chicago
Illinois · 36818
Office
Unavailable
Facility
$713.40
No comparable office rate is available.
Indiana
Indiana · 36818
Office
Unavailable
Facility
$567.25
No comparable office rate is available.
Kansas
Kansas · 36818
Office
Unavailable
Facility
$566.24
No comparable office rate is available.
Kentucky
Kentucky · 36818
Office
Unavailable
Facility
$606.27
No comparable office rate is available.
New Orleans
Louisiana · 36818
Office
Unavailable
Facility
$635.19
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 36818
Office
Unavailable
Facility
$610.15
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 36818
Office
Unavailable
Facility
$657.85
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 36818
Office
Unavailable
Facility
$620.91
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 36818
Office
Unavailable
Facility
$668.20
No comparable office rate is available.
Rest Of Maryland
Maryland · 36818
Office
Unavailable
Facility
$625.77
No comparable office rate is available.
Rest Of Maine
Maine · 36818
Office
Unavailable
Facility
$580.24
No comparable office rate is available.
Southern Maine
Maine · 36818
Office
Unavailable
Facility
$589.90
No comparable office rate is available.
Detroit
Michigan · 36818
Office
Unavailable
Facility
$694.18
No comparable office rate is available.
Rest Of Michigan
Michigan · 36818
Office
Unavailable
Facility
$631.02
No comparable office rate is available.
Minnesota
Minnesota · 36818
Office
Unavailable
Facility
$560.46
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 36818
Office
Unavailable
Facility
$618.74
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 36818
Office
Unavailable
Facility
$622.89
No comparable office rate is available.
Rest Of Missouri
Missouri · 36818
Office
Unavailable
Facility
$608.95
No comparable office rate is available.
Mississippi
Mississippi · 36818
Office
Unavailable
Facility
$584.88
No comparable office rate is available.
Montana**
Montana · 36818
Office
Unavailable
Facility
$628.40
No comparable office rate is available.
North Carolina
North Carolina · 36818
Office
Unavailable
Facility
$583.57
No comparable office rate is available.
North Dakota**
North Dakota · 36818
Office
Unavailable
Facility
$568.09
No comparable office rate is available.
Nebraska
Nebraska · 36818
Office
Unavailable
Facility
$555.75
No comparable office rate is available.
New Hampshire
New Hampshire · 36818
Office
Unavailable
Facility
$620.92
No comparable office rate is available.
Northern Nj
New Jersey · 36818
Office
Unavailable
Facility
$680.67
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 36818
Office
Unavailable
Facility
$665.96
No comparable office rate is available.
New Mexico
New Mexico · 36818
Office
Unavailable
Facility
$638.85
No comparable office rate is available.
Nevada**
Nevada · 36818
Office
Unavailable
Facility
$611.72
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 36818
Office
Unavailable
Facility
$765.03
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 36818
Office
Unavailable
Facility
$679.86
No comparable office rate is available.
Queens
New York · 36818
Office
Unavailable
Facility
$721.89
No comparable office rate is available.
Rest Of New York
New York · 36818
Office
Unavailable
Facility
$592.19
No comparable office rate is available.
Ohio
Ohio · 36818
Office
Unavailable
Facility
$618.70
No comparable office rate is available.
Oklahoma
Oklahoma · 36818
Office
Unavailable
Facility
$592.70
No comparable office rate is available.
Portland
Oregon · 36818
Office
Unavailable
Facility
$622.66
No comparable office rate is available.
Rest Of Oregon
Oregon · 36818
Office
Unavailable
Facility
$597.86
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 36818
Office
Unavailable
Facility
$660.58
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 36818
Office
Unavailable
Facility
$612.90
No comparable office rate is available.
Puerto Rico
Puerto Rico · 36818
Office
Unavailable
Facility
$628.43
No comparable office rate is available.
Rhode Island
Rhode Island · 36818
Office
Unavailable
Facility
$629.34
No comparable office rate is available.
South Carolina
South Carolina · 36818
Office
Unavailable
Facility
$603.96
No comparable office rate is available.
South Dakota**
South Dakota · 36818
Office
Unavailable
Facility
$560.96
No comparable office rate is available.
Tennessee
Tennessee · 36818
Office
Unavailable
Facility
$570.22
No comparable office rate is available.
Austin
Texas · 36818
Office
Unavailable
Facility
$624.95
No comparable office rate is available.
Beaumont
Texas · 36818
Office
Unavailable
Facility
$610.28
No comparable office rate is available.
Brazoria
Texas · 36818
Office
Unavailable
Facility
$608.31
No comparable office rate is available.
Dallas
Texas · 36818
Office
Unavailable
Facility
$617.28
No comparable office rate is available.
Fort Worth
Texas · 36818
Office
Unavailable
Facility
$617.37
No comparable office rate is available.
Galveston
Texas · 36818
Office
Unavailable
Facility
$613.45
No comparable office rate is available.
Houston
Texas · 36818
Office
Unavailable
Facility
$669.27
No comparable office rate is available.
Rest Of Texas
Texas · 36818
Office
Unavailable
Facility
$612.44
No comparable office rate is available.
Utah
Utah · 36818
Office
Unavailable
Facility
$610.82
No comparable office rate is available.
Virginia
Virginia · 36818
Office
Unavailable
Facility
$596.56
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 36818
Office
Unavailable
Facility
$628.43
No comparable office rate is available.
Vermont
Vermont · 36818
Office
Unavailable
Facility
$577.05
No comparable office rate is available.
Rest Of Washington
Washington · 36818
Office
Unavailable
Facility
$616.03
No comparable office rate is available.
Seattle (King Cnty)
Washington · 36818
Office
Unavailable
Facility
$658.11
No comparable office rate is available.
Wisconsin
Wisconsin · 36818
Office
Unavailable
Facility
$552.93
No comparable office rate is available.
West Virginia
West Virginia · 36818
Office
Unavailable
Facility
$656.37
No comparable office rate is available.
Wyoming**
Wyoming · 36818
Office
Unavailable
Facility
$602.12
No comparable office rate is available.
See how rates vary across the country
36818 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Modesto is a Medicare payment area. Our Census mapping connects it to 33 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 36818 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$660.03
$600.03 × 110% = $660.03
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 36818 in Modesto.
PPRRVU2026_Oct_nonQPP.csv
4,546
- Code
- 36818
- Physician work
- 12.08
- Practice expense
- 3.69
- Malpractice
- 3.05
GPCI2026.csv
16
- Locality
- Modesto
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.08 | × 1.017 | 12.2854 |
| Practice expense | 3.69 | × 1.096 | 4.0442 |
| Malpractice | 3.05 | × 0.536 | 1.6348 |
| Total RVUs | 17.9644 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Modesto$600.03
Open 36818 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.08 | 1.017 |
| Practice expense | 3.69 | 1.096 |
| Malpractice | 3.05 | 0.536 |
(12.08 × 1.017 + 3.69 × 1.096 + 3.05 × 0.536) × $33.4009 = $600.03
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
36818 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $600.03 | RVU26D |
| 2026-07-01 | Not available in this setting | $600.03 | RVU26C |
| 2026-04-01 | Not available in this setting | $600.03 | RVU26B |
| 2026-01-01 | Not available in this setting | $600.03 | RVU26A |
| 2025-10-01 | Not available in this setting | $633.08 | RVU25D |
| 2025-07-01 | Not available in this setting | $633.08 | RVU25C |
| 2025-04-01 | Not available in this setting | $633.08 | RVU25B |
| 2025-01-01 | Not available in this setting | $633.08 | RVU25A |
36818 billing questions
How does 36818 differ from 36819?
36818 describes access creation using an upper-arm cephalic vein transposition. 36819 is the corresponding upper-arm procedure using a basilic vein.
Is the vein transposition part of the fistula creation service?
Yes. The code represents creation of the access using upper-arm cephalic vein transposition, including the anastomosis that establishes the fistula.
Should modifier 50 be reported for access created in both arms?
No. CMS identifies bilateral adjustment as inappropriate for this code. Modifier 50 should not be used.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,54336800,,Insertion of cannula,A,,2.37,0.58,NA,0.58,,0.27,3.22,3.22,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54436810,,Insertion of cannula,A,,3.86,1.11,NA,1.11,,0.34,5.31,5.31,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54536815,,Insertion of cannula,A,,2.55,0.50,NA,0.50,,0.64,3.69,3.69,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54636818,,Av fuse uppr arm cephalic,A,,12.08,3.69,NA,3.69,,3.05,18.82,18.82,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54736819,,Av fuse uppr arm basilic,A,,12.96,3.60,NA,3.60,,3.31,19.87,19.87,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54836820,,Av fusion/forearm vein,A,,12.74,3.89,NA,3.89,,3.24,19.87,19.87,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54936821,,Av fusion direct any site,A,,11.60,3.44,NA,3.44,,2.95,17.99,17.99,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623
1901112,CA,61,REDDING,1.017,1.096,0.536