$10,270.65
36836 represents the initial single access site. Use 36837 for each additional separate access site in the same percutaneous fistula-creation service.
On this page
CMS RVU26D · Effective 2026-10-01
36836 AV fistula creation Medicare reimbursement rates in Hawaii
Report this service when a clinician creates hemodialysis access percutaneously between an artery and vein in an upper extremity through one access site. Compare 36836 office and facility rates across CMS payment localities in Hawaii.
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 36836 in Hawaii?
Hawaii 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
$9082.11
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$305.28
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 36836: Percutaneous upper-extremity AV fistula creation
Report this service when a clinician creates hemodialysis access percutaneously between an artery and vein in an upper extremity through one access site.
This service establishes a native arteriovenous connection in an upper extremity for hemodialysis using a percutaneous, catheter-based approach rather than an open surgical anastomosis. Vascular surgeons and interventional specialists typically perform it in a hospital or outpatient setting. The code represents creation through a single access site, not a surgical fistula made through an open incision or an arteriovenous graft.
Report one unit for the single access-site service. When another separate access site is used to create an additional fistula, report add-on code 36837 with 36836. The operative report should identify the limb, artery and vein, percutaneous approach, and access-site count. The 0-day global period includes same-day preoperative and postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 36836
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.02 · 3%
- Practice expense (office) RVU232.45 · 97%
- Malpractice RVU1.03 · 0%
1K
Medicare services in 2024 · #2964 by national volume
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.
36836 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
36821 is an open direct fistula-creation service; 36836 is the percutaneous approach.
No office rate
36818 describes open upper-arm fistula creation using the cephalic vein. Choose 36836 when the fistula is created percutaneously.
No office rate
36825 creates access with an autogenous graft. 36836 creates a direct artery-to-vein connection percutaneously.
Compare 36836 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
$9082.11
Facility
$305.28
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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 36836 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
4,557
- Code
- 36836
- Physician work
- 7.02
- Practice expense
- 232.45
- Malpractice
- 1.03
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.02 | × 1.000 | 7.0200 |
| Practice expense | 232.45 | × 1.137 | 264.2956 |
| Malpractice | 1.03 | × 0.579 | 0.5964 |
| Total RVUs | 271.9120 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$9082.11
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.02 | 1 |
| Practice expense | 232.45 | 1.137 |
| Malpractice | 1.03 | 0.579 |
(7.02 × 1 + 232.45 × 1.137 + 1.03 × 0.579) × $33.4009 = $9082.11
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.02 | 1 |
| Practice expense | 1.34 | 1.137 |
| Malpractice | 1.03 | 0.579 |
(7.02 × 1 + 1.34 × 1.137 + 1.03 × 0.579) × $33.4009 = $305.28
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.
36836 billing questions
How is 36836 different from open fistula creation?
36836 describes percutaneous creation of the upper-extremity arteriovenous connection. Open surgical fistula codes, such as 36821, describe a different approach.
How is an additional access site reported?
Report 36837 with 36836 for each additional separate access site used to create a fistula.
Can modifier 50 be used for bilateral fistula creation?
No. Modifier 50 is inappropriate for 36836.
What documentation supports 36836?
Document the percutaneous technique, the artery and vein connected, the upper-extremity site, and the number of access sites used.
What same-day care is included?
The 0-day global period includes preoperative and postoperative care on the procedure date.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the session are subject to the standard multiple-procedure reduction.
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.
4,55436832,,Av fistula revision open,A,,13.16,4.13,NA,4.13,,3.32,20.61,20.61,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,55536833,,Av fistula revision,A,,14.14,4.30,NA,4.30,,3.61,22.05,22.05,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,55636835,,Insertion thomas shunt,A,,7.32,5.11,NA,5.11,,1.84,14.27,14.27,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,55736836,,Prq av fstl crtj uxtr 1 acs,A,,7.02,232.45,,1.34,,1.03,240.50,9.39,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,55836837,,Prq av fstl crt uxtr sep acs,A,,9.07,261.75,,1.52,,1.41,272.23,12.00,0,000,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,55936838,,Dist revas ligation hemo,A,,21.15,4.31,NA,4.31,,5.39,30.85,30.85,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,56036860,,External cannula declotting,A,,1.96,5.26,,0.47,,0.51,7.73,2.94,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,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