Billing code 36818: AV fistula creationMedicare rate & RVUs in Florida
Report this open operation to create hemodialysis access by transposing an upper-arm cephalic vein and connecting it to an artery.
CMS doesn’t publish an office rate for 36818 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 36818 covers
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.
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 36818 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 | $712.52 |
| Miami | Unavailable | $789.42 |
| Rest Of Florida | Unavailable | $674.42 |
How the 36818 rate is calculated
Each of 36818’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 · 36818
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.08Practice expense 3.69Malpractice 3.05
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 36818
36818 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 36818
AV fistula creation
| 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 · 36818
AV fistula creation
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
36818 without 51 · national facility
$628.60
AV fistula creation
36818-51 · Second procedure: 50%
$314.30
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%).
36818 compared with similar codes
Compare codes
36818 vs 36819 vs 36821 vs 36825: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 36819Dialysis access
- Choose 36818 for an upper-arm cephalic vein transposition; choose 36819 when the upper-arm basilic vein is used.
- 36821Dialysis access
- 36821 describes direct open artery-to-vein access creation. 36818 is specific to creating access with upper-arm cephalic vein transposition.
- 36825Dialysis access
- 36825 uses an autogenous graft to create access. 36818 uses the patient's transposed upper-arm cephalic vein.
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 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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