Billing code 37140: Portacaval shuntMedicare rate & RVUs in Guam
Reports open creation of a connection between the portal vein and inferior vena cava to decompress portal hypertension, such as in selected patients with variceal bleeding.
CMS doesn’t publish an office rate for 37140 in Guam.
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 37140 covers
A vascular surgeon creates an open connection between the portal venous system and the inferior vena cava, diverting portal blood to reduce portal pressure. The operation is used in selected patients with portal hypertension, including some with recurrent variceal hemorrhage when surgical shunting is chosen. It is a major abdominal procedure, generally performed in a hospital operating room; the operative report should identify the veins connected and describe construction of the shunt.
Report this code for the portacaval route, not a shunt using a different venous connection or an endovascular TIPS procedure. Documentation should establish the anatomy, operative approach, and completed anastomosis. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is statutorily restricted; 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.
37140 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $2,057.29 |
How the 37140 rate is calculated
Each of 37140’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 · 37140
RVUs × geographic indexes × conversion factor
Work39.00
39.00 RVUs× 1.000 GPCI
Practice expense14.55
14.55 RVUs× 1.000 GPCI
Malpractice10.45
10.45 RVUs× 1.000 GPCI
Adjusted RVUs
64.0000
Conversion factor
$33.4009
Medicare rate
$2,137.66
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 37140
37140 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 37140
Portacaval shunt
| 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) | 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 · 37140
Portacaval shunt
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
37140 without 51 · national facility
$2,137.66
Portacaval shunt
37140-51 · Second procedure: 50%
$1,068.83
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%).
37140 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 37145Surgical shunt
- This code is for the portacaval route. Choose 37145 when the open shunt uses the renal venous route.
- 37160Shunt revision
- This code describes a portacaval connection; 37160 is for an open mesenteric-to-caval shunt.
- 37182TIPS placement
- Use 37182 for endovascular TIPS creation through a transjugular approach, not an open portacaval shunt.
37140 billing questions
How is this code distinguished from other surgical shunt codes?
Use it for an open connection from the portal venous system to the inferior vena cava. A different venous route, such as a renal or mesenteric connection, belongs to its corresponding code.
Is this the code for a TIPS procedure?
No. This code describes an open abdominal portacaval shunt; TIPS is created through an endovascular, transjugular approach.
Can modifier 50 be used for a bilateral procedure?
No. Modifier 50 is inappropriate for this code’s anatomy and descriptor.
What documentation supports reporting the procedure?
The operative report should identify the portal and caval venous anatomy, confirm the open approach, and describe creation of the portacaval anastomosis.
How are assistant and co-surgeon services handled?
Medicare payment for an assistant at surgery is statutorily restricted. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
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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