No office rate
Use 36820 for the forearm-vein access technique. This code describes a direct artery-to-vein connection at any site, so compare the documented anatomy and construction.
On this page
CMS RVU26D · Effective 2026-10-01
36821 Dialysis access Medicare reimbursement rates in Massachusetts
Report this code when a surgeon creates hemodialysis access by directly connecting a native artery and vein without an interposed graft. Compare 36821 office and facility rates across CMS payment localities in Massachusetts.
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 36821 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$593.17–$628.22
2 of 2 localities have a supported rate.
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 access surgery
About 36821: Direct arteriovenous fistula creation
Report this code when a surgeon creates hemodialysis access by directly connecting a native artery and vein without an interposed graft.
A vascular surgeon creates a direct connection between a native artery and a native vein to establish an arteriovenous access for hemodialysis. The procedure is generally performed in an operating room, including hospital outpatient or inpatient settings. The operative report should identify the vessels and site, describe the direct connection, and make clear that no graft was used.
Select this code when the documented construction is a direct artery-to-vein anastomosis, rather than a site-specific technique or a graft-based access. The code has 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 50% reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team-surgery billing is not permitted.
CMS billing rules for 36821
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU11.60 · 64%
- Practice expense (office) RVU3.44 · 19%
- Malpractice RVU2.95 · 16%
22.6K
Medicare services in 2024 · #1094 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.
36821 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
This code is for a direct native-vessel connection; 36825 is used when an autogenous graft is used to construct the access.
No office rate
This code describes direct native-vessel access. Use 36830 when the access is constructed with a nonautologous graft.
Compare 36821 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$628.22
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$593.17
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36821 billing questions
How is this code distinguished from 36820?
This code describes a direct artery-to-vein connection at any site. Code 36820 identifies the forearm-vein technique; use the operative details and applicable site-specific code description to select between them.
Can this code be used when a graft is placed?
No. It describes a direct connection between native vessels without an interposed graft. A graft-based access is represented by a different code, with the choice depending on graft material.
Are the preoperative visit and postoperative care separately reported?
The day-before preoperative visit and related postoperative care during the 90-day global period are included in this surgery's global payment.
Can modifier 50 be used for access creation on both sides?
Modifier 50 is inappropriate for this code. Report the service based on the documented operative site and procedure.
How are assistant and co-surgeon services handled?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team-surgery billing is not permitted.
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.
4,54636818,,Av fuse uppr arm cephalic,A,,12.08,3.69,NA,3.69,,3.05,18.82,18.82,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54736819,,Av fuse uppr arm basilic,A,,12.96,3.60,NA,3.60,,3.31,19.87,19.87,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54836820,,Av fusion/forearm vein,A,,12.74,3.89,NA,3.89,,3.24,19.87,19.87,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54936821,,Av fusion direct any site,A,,11.60,3.44,NA,3.44,,2.95,17.99,17.99,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,55036823,,Insertion of cannula(s),A,,22.41,11.02,NA,11.02,,6.00,39.43,39.43,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,55136825,,Artery-vein autograft,A,,13.82,4.22,NA,4.22,,3.55,21.59,21.59,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,55236830,,Artery-vein nonautograft,A,,11.73,3.45,NA,3.45,,3.00,18.18,18.18,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00