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CMS RVU26D · Effective 2026-10-01

36406 Pediatric venipuncture Medicare reimbursement rates in Kentucky

Physician- or qualified-practitioner venipuncture from a non-scalp, non-femoral or jugular vein in a child younger than three when skilled access is required. Compare 36406 office and facility rates across CMS payment localities in Kentucky.

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 36406 in Kentucky?

Kentucky 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

$17.01

1 of 1 localities have a supported rate.

Payment area: Kentucky

One mapped payment locality.

Facility setting

$7.51

1 of 1 localities have a supported rate.

Payment area: Kentucky

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.

Find 36406 in your payment locality →

Venipuncture

About 36406: Skilled venipuncture in a child under three

Physician- or qualified-practitioner venipuncture from a non-scalp, non-femoral or jugular vein in a child younger than three when skilled access is required.

This service is a venous puncture in a child younger than three that requires a physician’s or qualified health care professional’s skill. It covers access through a vein other than the scalp, femoral, or jugular sites represented by neighboring codes. Examples of other sites include peripheral veins in the hand, foot, or arm. It may be performed in a hospital, clinic, or other setting where the child needs a venous specimen or venous access for a clinical purpose.

Report the code for the skilled puncture, not for the laboratory test performed on the specimen. Documentation should identify the child’s age, the vein accessed, the clinical purpose, and the circumstances supporting the need for physician or qualified-practitioner skill. 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.

CMS billing rules for 36406

Multiple procedures
Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.

Where the value comes from

  • Work RVU0.18 · 33%
  • Practice expense (office) RVU0.36 · 65%
  • Malpractice RVU0.01 · 2%

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.

36406 compared with similar codes

Office rates for Kentucky, from the same CMS release.

36400

Venipuncture

Under age three, femoral or jugular

$25.74

Use 36400 for femoral or jugular access in a child younger than three. This code is for another vein.

36405

Scalp venipuncture

Younger than 3 years

$22.51

Use 36405 for scalp-vein access in a child younger than three. This code covers other venous sites.

36410

Skilled venipuncture

Age three or older

$17.61

Use 36410 for skilled venipuncture in a patient age three or older; this code is for children younger than three.

36415

Coll venous bld venipuncture

No office rate

Code 36415 represents routine venous blood collection. This code represents a pediatric puncture requiring physician or qualified-practitioner skill.

Compare 36406 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

Office and facility base rates · shared scale starting at $0

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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 36406 in Kentucky.

PPRRVU2026_Oct_nonQPP.csv

4,469

Code
36406
Physician work
0.18
Practice expense
0.36
Malpractice
0.01

GPCI2026.csv

55

Locality
Kentucky
Physician work
1.000
Practice expense
0.889
Malpractice
0.915
Office / nonfacility calculation for 36406 in Kentucky
ComponentRVULocality factorAdjusted
Physician work0.18× 1.0000.1800
Practice expense0.36× 0.8890.3200
Malpractice0.01× 0.9150.0092
Total RVUs0.5092
Conversion factor× 33.4009

Office / nonfacility rate, Kentucky$17.01

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.
Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.181
Practice expense0.360.889
Malpractice0.010.915

(0.18 × 1 + 0.36 × 0.889 + 0.01 × 0.915) × $33.4009 = $17.01

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work0.181
Practice expense0.040.889
Malpractice0.010.915

(0.18 × 1 + 0.04 × 0.889 + 0.01 × 0.915) × $33.4009 = $7.51

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.

36406 billing questions

How does this code differ from 36405 and 36400?

This code is for a vein other than the scalp, femoral, or jugular vein. Code 36405 is for scalp access, while 36400 is for femoral or jugular access in a child younger than three.

When is 36410 used instead?

Code 36410 is the related venipuncture code for a patient age three or older when physician or qualified-practitioner skill is required.

Does this code include laboratory testing?

No. It represents the skilled venipuncture; the laboratory analysis is a separate service.

Can routine staff-performed blood collection be reported with this code?

The code describes venipuncture requiring physician or qualified-practitioner skill. A routine collection without that skilled service does not fit this code.

How does the multiple-procedure reduction affect payment?

For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are paid at 50% under the standard multiple-procedure reduction.

What should the record show?

Document the child’s age, the access site, the clinical purpose, and why the puncture required physician or qualified-practitioner skill.

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.

RVUs for 36406PPRRVU2026_Oct_nonQPP.csv, line 4,469 (RVU26D)
Geographic factors for KentuckyGPCI2026.csv, line 55 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet