36820 AV fistula Medicare reimbursement rates in Iowa

Code 36820 represents open creation of arteriovenous access using transposition of a native forearm vein. The surgeon mobilizes and repositions the vein to provide a usable superficial access route, then establishes the artery-to-vein connection. Vascular surgeons typically perform this operation in an operating room for a patient who needs durable hemodialysis access and whose anatomy supports use of a forearm vein.

Choose this code when the operative technique includes forearm vein transposition; a direct anastomosis without that transposition or an upper-arm vein transposition is coded differently. The operative report should identify the forearm vein and arterial connection, describe the transposition and anastomosis, and document the side. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% multiple-procedure reduction. Modifier 50 reports bilateral performance and is paid at 150%. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.