Billing code 37181: Splenorenal shuntMedicare rate & RVUs in Alaska
Reports open creation of a connection between the splenic and renal veins to divert portal blood in selected patients with portal hypertension.
CMS doesn’t publish an office rate for 37181 in Alaska.
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 9 sections
What 37181 covers
This operation creates an open surgical connection between the splenic vein and a renal vein, redirecting blood away from the portal circulation. It may be used for portal hypertension, including selected patients with complications such as bleeding varices. A vascular, transplant, or other surgeon experienced in portal-hypertension surgery typically performs it in an operating room through an abdominal approach.
Report 37181 for creation of the splenorenal shunt, not for a different portosystemic shunt configuration or revision of an existing shunt. The operative report should identify the veins joined and document that a new shunt was created. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed 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 anatomy. Assistant-at-surgery payment may be available; 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.
37181 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | Unavailable | $2,663.85 |
How the 37181 rate is calculated
Each of 37181’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 · 37181
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 39.00Practice expense 14.55Malpractice 10.45
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 37181
37181 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 37181
Splenorenal shunt
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 37181
Splenorenal shunt
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
37181 without 51 · national facility
$2,137.66
Splenorenal shunt
37181-51 · Second procedure: 50%
$1,068.83
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%).
37181 compared with similar codes
Compare codes
37181 vs 37180 vs 37182 vs 37183 vs 37145: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 37180Shunt revision
- Use 37181 when the operation creates a splenorenal shunt. Choose the other open-shunt code when the documented shunt anatomy is different.
- 37182TIPS placement
- 37182 is an endovascular, transjugular intrahepatic shunt procedure; 37181 is open creation of a splenic-vein-to-renal-vein connection.
- 37183TIPS revision
- 37183 concerns revision of an existing TIPS. It is not the code for creating a new open splenorenal shunt.
- 37145Surgical shunt
- 37145 is for revision of a previously created surgical shunt or bypass; 37181 reports creation of the splenorenal shunt.
37181 billing questions
How is this code distinguished from 37182?
37181 describes open surgical creation of a splenorenal connection. Code 37182 is for a transjugular intrahepatic portosystemic shunt, a different approach and shunt pathway.
Does the 90-day global period include postoperative visits?
Related postoperative care during the 90 days after surgery is included, along with the day-before preoperative visit.
Can modifier 50 be reported?
No. The splenorenal anatomy makes bilateral adjustment inappropriate for this code.
What supports reporting an assistant or co-surgeon?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, while team surgery is not permitted under the CMS rules provided.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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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