Billing code 36835: Dialysis accessMedicare rate & RVUs in Florida
Operative placement of a Thomas external arteriovenous shunt creates a hemodialysis access route using surgically placed arterial and venous cannulae.
CMS doesn’t publish an office rate for 36835 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 36835 covers
Code 36835 describes operative placement of a Thomas shunt, an external arteriovenous access for hemodialysis. The surgeon places arterial and venous cannulae and connects them through external tubing, creating a route for dialysis blood flow that remains outside the body. Vascular surgeons generally perform the operation in an operating room for a patient requiring hemodialysis access when an external shunt is selected rather than an internal fistula or graft.
Report 36835 when the operative documentation supports insertion of a Thomas-type external shunt; do not substitute it for creation of an internal AV fistula or graft. The operative report should identify the external shunt and document its placement, rather than only cannulation or revision of an existing access. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure setting, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate; assistant-at-surgery services are restricted from payment, and co-surgery and team surgery are 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 36835 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 | $528.51 |
| Miami | Unavailable | $577.60 |
| Rest Of Florida | Unavailable | $500.03 |
How the 36835 rate is calculated
Each of 36835’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 · 36835
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.32Practice expense 5.11Malpractice 1.84
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 36835
36835 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 36835
Dialysis access
| 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 36835
Dialysis access
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
36835 without 51 · national facility
$476.63
Dialysis access
36835-51 · Second procedure: 50%
$238.32
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%).
36835 compared with similar codes
Compare codes
36835 vs 36821 vs 36825 vs 36830: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 36821Dialysis access
- Choose 36835 for a Thomas external shunt with cannulae and external tubing. Choose 36821 for creation of a direct internal artery-to-vein fistula.
- 36825Dialysis access
- Code 36825 describes an AV graft made with autogenous material; 36835 describes an external Thomas shunt.
- 36830AV graft creation
- Code 36830 describes an AV graft made with nonautologous material. It is not the code for insertion of a Thomas external shunt.
36835 billing questions
How is 36835 different from an AV fistula code such as 36821?
Use 36835 for insertion of a Thomas external shunt with cannulae and external tubing. Code 36821 describes creation of a direct internal artery-to-vein fistula.
How does a Thomas shunt differ from a dialysis graft?
A Thomas shunt is an external access. Codes 36825 and 36830 describe creation of an AV graft, using autogenous or nonautologous material, respectively.
Does this code describe isolated cannula placement?
The defining service is operative insertion of the Thomas external shunt. If the documentation describes only cannulation or work on an existing access, it does not establish that this shunt-insertion service was performed.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Which modifiers or additional surgeon claims are appropriate?
Modifier 50 is inappropriate for this procedure. Assistant-at-surgery services are restricted from payment, and co-surgeons and team surgery are 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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