Billing code 36450: Exchange transfusionMedicare rate & RVUs in Florida
Reports a newborn blood exchange that progressively removes circulating blood and replaces it with donor blood, commonly for severe neonatal hyperbilirubinemia.
CMS doesn’t publish an office rate for 36450 in Florida.
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 36450 covers
This service replaces a newborn’s circulating blood through a controlled process of withdrawing blood and infusing compatible donor blood. It is typically performed by a neonatologist or pediatrician in a hospital nursery or NICU. A common clinical situation is severe hyperbilirubinemia associated with hemolytic disease of the newborn. Vascular access may use an umbilical catheter, and the exchange is carried out in measured portions rather than as a routine transfusion.
Report 36450 for a newborn exchange, not for a simple transfusion or a partial exchange. Documentation should establish the newborn’s status, the clinical reason for the exchange, and that blood was removed and replaced as an exchange procedure. When multiple procedures subject to the standard multiple procedure reduction are performed in the same session, the highest-valued procedure is paid in full and the others are paid at 50%.
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 36450 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $149.92 |
| Miami | Unavailable | $155.63 |
| Rest Of Florida | Unavailable | $146.47 |
How the 36450 rate is calculated
Each of 36450’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 · 36450
RVUs × geographic indexes × conversion factor
Work3.41
3.41 RVUs× 1.000 GPCI
Practice expense0.69
0.69 RVUs× 1.000 GPCI
Malpractice0.21
0.21 RVUs× 1.000 GPCI
Adjusted RVUs
4.3100
Conversion factor
$33.4009
Medicare rate
$143.96
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 36450
The CMS indicators that decide how 36450 is paid alongside other services.
CMS payment indicators · 36450
Exchange transfusion
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| 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
36450 without 51 · national facility
$143.96
Exchange transfusion
36450-51 · Second procedure: 50%
$71.98
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%).
36450 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 36455Exchange transfusion
- Both describe exchange transfusion, but 36455 is for patients other than newborns; 36450 is the newborn code.
- 36456Blood exchange
- Use 36456 for a partial exchange in a newborn. Use 36450 when the documented service is a newborn exchange transfusion.
- 36430Blood transfusion
- 36430 describes transfusion of blood or blood components. It does not describe the removal-and-replacement process of an exchange.
- 36440Blood transfusion
- 36440 describes a push transfusion for a young child, not a newborn blood exchange.
36450 billing questions
How does 36450 differ from 36456?
36450 represents a newborn exchange transfusion; 36456 is for a partial exchange in a newborn. The record should support which type of exchange was performed.
Can 36450 be used for a routine newborn transfusion?
No. Use 36450 when blood is withdrawn and replaced as an exchange; a transfusion that simply administers blood is a different service.
Should 36430 also be reported for the donor blood used in the exchange?
Do not separately report 36430 for blood administration that is part of the same exchange service. Consider it only for a distinct transfusion service supported by the record.
What documentation supports reporting 36450?
Document the newborn’s clinical indication and the exchange procedure, including that blood was removed and replaced. A routine transfusion record alone does not establish an exchange.
How does the multiple procedure reduction affect payment?
When multiple procedures subject to the standard reduction are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
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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