Billing code 50436: Nephrostomy tract dilationMedicare rate & RVUs in Florida
Report this service when a clinician enlarges an established percutaneous nephrostomy tract to provide access for an endourologic procedure.
CMS doesn’t publish an office rate for 50436 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 50436 covers
A urologist or interventional radiologist enlarges an established nephrostomy tract through the skin to accommodate instruments needed for an endourologic procedure, such as accessing the collecting system for stone treatment. The service may take place in an operating room or an image-guided procedure suite. Imaging guidance, such as ultrasound or fluoroscopy, is included when performed as part of the tract dilation.
Report the code for dilation of an existing tract, not for creating a new nephrostomy access or simply exchanging a catheter. The operative or procedure note should establish that the tract already existed, explain the endourologic purpose of dilation, and describe the work performed; document imaging guidance when used. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and the others at 50%. For bilateral reporting with modifier 50, payment is at 150%. Assistant-at-surgery payment is restricted; co-surgeons 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 50436 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 | $146.16 |
| Miami | Unavailable | $155.55 |
| Rest Of Florida | Unavailable | $140.66 |
How the 50436 rate is calculated
Each of 50436’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 · 50436
RVUs × geographic indexes × conversion factor
Work2.71
2.71 RVUs× 1.000 GPCI
Practice expense1.02
1.02 RVUs× 1.000 GPCI
Malpractice0.35
0.35 RVUs× 1.000 GPCI
Adjusted RVUs
4.0800
Conversion factor
$33.4009
Medicare rate
$136.28
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 50436
The CMS indicators that decide how 50436 is paid alongside other services.
CMS payment indicators · 50436
Nephrostomy tract dilation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
50436 without 50 · national facility
$136.28
Nephrostomy tract dilation
50436-50 · Bilateral: 150%
$204.42
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
50436 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 50437Renal access dilation
- This is the related tract-dilation code for an existing nephrostomy access used for an endourologic procedure. Code 50437 represents a different access circumstance; select based on the documented tract and procedure.
- 50432Nephrostomy placement
- Use 50432 for percutaneous placement of a nephrostomy catheter. Use 50436 when the service is enlargement of an established nephrostomy tract for endourologic access.
- 50435Nephrostomy exchange
- Use 50435 for exchange of a nephrostomy catheter. Code 50436 describes dilation of the tract to permit endourologic access, not routine catheter exchange.
50436 billing questions
How is this different from code 50437?
Both codes describe nephrostomy-tract dilation for endourologic access, but they distinguish access circumstances. Review the operative documentation and the applicable billing code descriptor to determine which tract-dilation service was performed.
Can this code be used for a routine nephrostomy catheter exchange?
No. Code 50436 describes dilation of an existing tract for endourologic access, not routine catheter exchange; code 50435 describes nephrostomy catheter exchange.
Is imaging guidance separately reported?
Imaging guidance is included in the tract-dilation service when performed. The code does not describe a standalone diagnostic nephrostogram or ureterogram.
What documentation supports reporting this code?
Document that the nephrostomy tract was established before the service, why it needed enlargement for an endourologic procedure, and the dilation performed. Include the imaging guidance used, if any.
How does Medicare handle bilateral reporting and multiple procedures?
When reported bilaterally with modifier 50, payment is at 150%. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. 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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