Billing code 37607: Access fistula procedureMedicare rate & RVUs in Illinois
Reports surgical closure or flow reduction of an existing dialysis-access arteriovenous fistula, commonly for access-related hand ischemia or excessive shunting.
CMS doesn’t publish an office rate for 37607 in Illinois.
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 37607 covers
A vascular surgeon ligates an existing arteriovenous access fistula to stop its flow or places a band to reduce flow while preserving access. Typical situations include access-related hand ischemia or excessive shunting that contributes to cardiac strain. The service is performed in an operative setting; the operative note should identify the access and explain whether it was closed or flow-reduced and why intervention was needed.
This is a major surgery with a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery; co-surgeon payment requires 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.
Where 37607 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $411.94 |
| East St. Louis | Unavailable | $388.70 |
| Rest Of Illinois | Unavailable | $365.76 |
| Suburban Chicago | Unavailable | $388.14 |
How the 37607 rate is calculated
Each of 37607’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 · 37607
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.09Practice expense 2.79Malpractice 1.48
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 37607
37607 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 37607
Access fistula procedure
| 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 · 37607
Access fistula procedure
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
37607 without 51 · national facility
$346.03
Access fistula procedure
37607-51 · Second procedure: 50%
$173.02
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%).
37607 compared with similar codes
Compare codes
37607 vs 36821 vs 36832 vs 36833: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 36821Dialysis access
- 36821 establishes a direct arteriovenous access. Use 37607 for an existing access that is being closed or have its flow reduced.
- 36832Fistula revision
- 36832 describes revision of an existing fistula. Choose 37607 when the documented procedure instead ligates the access or reduces its flow by banding.
- 36833Fistula revision
- 36833 is for fistula revision with thrombectomy. It is distinct from 37607, which addresses closure or flow reduction rather than clot removal with revision.
37607 billing questions
When should this code be chosen over an access revision code?
Use 37607 when the operative goal is to close the existing fistula or reduce its flow with banding. A revision code describes a different operation intended to revise or salvage the access.
Can modifier 50 be used when a patient has access fistulas on both sides?
No. The CMS facts specify that bilateral adjustment does not apply and modifier 50 is inappropriate for this service.
What documentation supports reporting 37607?
Document the fistula treated, the clinical reason for intervention, and the operative method and result, such as closure or flow reduction by banding.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and related postoperative care for 90 days are included in the global period. The period begins with the surgery.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are reduced when performed in the same session.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery, and team surgery is not permitted. Co-surgeons are paid only when supporting documentation is provided.
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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