No office rate
Use 37181 when the operation creates a splenorenal shunt. Choose the other open-shunt code when the documented shunt anatomy is different.
On this page
CMS RVU26D · Effective 2026-10-01
37181 Splenorenal shunt Medicare reimbursement rates in Colorado
Reports open creation of a connection between the splenic and renal veins to divert portal blood in selected patients with portal hypertension. Compare 37181 office and facility rates across CMS payment localities in Colorado.
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.
What does Medicare pay for 37181 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$2107.95
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Vascular surgery
About 37181: Open splenorenal shunt creation
Reports open creation of a connection between the splenic and renal veins to divert portal blood in selected patients with portal hypertension.
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.
CMS billing rules for 37181
- 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 RVU39.00 · 61%
- Practice expense (office) RVU14.55 · 23%
- Malpractice RVU10.45 · 16%
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 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
37182 is an endovascular, transjugular intrahepatic shunt procedure; 37181 is open creation of a splenic-vein-to-renal-vein connection.
$5,728.99
37183 concerns revision of an existing TIPS. It is not the code for creating a new open splenorenal shunt.
No office rate
37145 is for revision of a previously created surgical shunt or bypass; 37181 reports creation of the splenorenal shunt.
Compare 37181 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Colorado →
Office / nonfacility
Unavailable
Facility
$2107.95
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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 37181 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
4,576
- Code
- 37181
- Physician work
- 39.00
- Practice expense
- 14.55
- Malpractice
- 10.45
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 39.00 | × 1.012 | 39.4680 |
| Practice expense | 14.55 | × 1.064 | 15.4812 |
| Malpractice | 10.45 | × 0.781 | 8.1615 |
| Total RVUs | 63.1107 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$2107.95
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 39 | 1.012 |
| Practice expense | 14.55 | 1.064 |
| Malpractice | 10.45 | 0.781 |
(39 × 1.012 + 14.55 × 1.064 + 10.45 × 0.781) × $33.4009 = $2107.95
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.
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 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.
4,57337145,,Revision of circulation,A,,36.08,13.70,NA,13.70,,9.67,59.45,59.45,0,090,0.09,0.84,0.07,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,57437160,,Revision of circulation,A,,37.05,14.07,NA,14.07,,9.93,61.05,61.05,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,57537180,,Revision of circulation,A,,35.59,13.59,NA,13.59,,9.54,58.72,58.72,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,57637181,,Splice spleen/kidney veins,A,,39.00,14.55,NA,14.55,,10.45,64.00,64.00,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,57737182,,Insert hepatic shunt (tips),A,,16.55,2.59,NA,2.59,,1.85,20.99,20.99,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,57837183,,Revision tips,A,,7.55,153.40,,1.24,,0.85,161.80,9.64,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,57937184,,Prim art m-thrmbc 1st vsl,A,,8.20,39.12,,1.56,,1.51,48.83,11.27,0,000,0.00,0.00,0.00,2,1,1,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899