No office rate
Use 37145 for the portal-to-hepatic vein configuration. 37140 describes other surgical shunts or bypasses, such as mesocaval or mesoatrial procedures.
On this page
CMS RVU26D · Effective 2026-10-01
37145 Surgical shunt Medicare reimbursement rates in Guam
Open portal-to-hepatic vein shunt or bypass surgery redirects portal blood flow, typically as a surgical treatment for portal hypertension. Compare 37145 office and facility rates across CMS payment localities in Guam.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 37145 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1912.40
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Vascular surgery
About 37145: Portal-to-hepatic vein surgical shunt
Open portal-to-hepatic vein shunt or bypass surgery redirects portal blood flow, typically as a surgical treatment for portal hypertension.
This code represents an open surgical shunt connecting the portal vein with a hepatic vein to redirect blood flow. A vascular or transplant surgeon performs the operation in a hospital operating room, generally to address portal hypertension when a surgically constructed bypass is selected. It is distinct from an endovascular TIPS procedure, which creates an intrahepatic channel using a catheter-based approach.
Report the code for the documented portal-to-hepatic vein surgical configuration, not for a different shunt anatomy or a TIPS revision. The operative report should identify the vessels joined and the bypass performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Assistant-at-surgery services may be paid; co-surgeons and team surgery are not permitted. Modifier 50 is inappropriate for this code.
CMS billing rules for 37145
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU36.08 · 61%
- Practice expense (office) RVU13.70 · 23%
- Malpractice RVU9.67 · 16%
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.
37145 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
37180 is for a splenorenal shunt configuration, not a portal-to-hepatic vein bypass.
No office rate
37181 describes a splenic-to-renal vein shunt configuration; 37145 is selected for the portal-to-hepatic vein configuration.
No office rate
37182 describes endovascular TIPS creation. 37145 is for the specified open surgical shunt.
Compare 37145 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$1912.40
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 37145 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
4,573
- Code
- 37145
- Physician work
- 36.08
- Practice expense
- 13.70
- Malpractice
- 9.67
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 36.08 | × 1.000 | 36.0800 |
| Practice expense | 13.70 | × 1.137 | 15.5769 |
| Malpractice | 9.67 | × 0.579 | 5.5989 |
| Total RVUs | 57.2558 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$1912.40
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 36.08 | 1 |
| Practice expense | 13.7 | 1.137 |
| Malpractice | 9.67 | 0.579 |
(36.08 × 1 + 13.7 × 1.137 + 9.67 × 0.579) × $33.4009 = $1912.40
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
37145 billing questions
How is this code different from 37140?
37145 identifies a portal-to-hepatic vein shunt configuration. 37140 covers other surgical shunt or bypass configurations, such as mesocaval or mesoatrial.
Can this code be reported for a TIPS procedure?
No. TIPS is an endovascular procedure; 37182 describes TIPS creation. Report 37145 for the specified open surgical shunt configuration.
Is modifier 50 appropriate?
No. CMS identifies bilateral adjustment as inappropriate for this code.
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?
Assistant-at-surgery services may be paid. Co-surgeons and team surgery are not permitted under the CMS rules for this code.
What documentation supports choosing 37145?
The operative report should identify the portal vein and hepatic vein as the vessels connected and describe the surgical bypass performed.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
4,57036909,,Dialysis circuit embolj,A,,4.02,49.70,,0.57,,0.67,54.39,5.26,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,5713700F,,Psych disorders assessed,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,57237140,,Revision of circulation,A,,39.00,14.55,NA,14.55,,10.45,64.00,64.00,0,090,0.09,0.84,0.07,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,57337145,,Revision of circulation,A,,36.08,13.70,NA,13.70,,9.67,59.45,59.45,0,090,0.09,0.84,0.07,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,57437160,,Revision of circulation,A,,37.05,14.07,NA,14.07,,9.93,61.05,61.05,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,57537180,,Revision of circulation,A,,35.59,13.59,NA,13.59,,9.54,58.72,58.72,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,57637181,,Splice spleen/kidney veins,A,,39.00,14.55,NA,14.55,,10.45,64.00,64.00,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014