No office rate
Choose 36835 for a Thomas external shunt with cannulae and external tubing. Choose 36821 for creation of a direct internal artery-to-vein fistula.
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CMS RVU26D · Effective 2026-10-01
36835 Dialysis access Medicare reimbursement rates in Massachusetts
Operative placement of a Thomas external arteriovenous shunt creates a hemodialysis access route using surgically placed arterial and venous cannulae. Compare 36835 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 36835 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
$477.11–$513.01
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 surgery
About 36835: Thomas external shunt insertion
Operative placement of a Thomas external arteriovenous shunt creates a hemodialysis access route using surgically placed arterial and venous cannulae.
Code 36835 describes operative placement of a Thomas shunt, an external arteriovenous access for hemodialysis. The surgeon places arterial and venous cannulae and connects them through external tubing, creating a route for dialysis blood flow that remains outside the body. Vascular surgeons generally perform the operation in an operating room for a patient requiring hemodialysis access when an external shunt is selected rather than an internal fistula or graft.
Report 36835 when the operative documentation supports insertion of a Thomas-type external shunt; do not substitute it for creation of an internal AV fistula or graft. The operative report should identify the external shunt and document its placement, rather than only cannulation or revision of an existing access. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure setting, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate; assistant-at-surgery services are restricted from payment, and co-surgery and team surgery are not permitted.
CMS billing rules for 36835
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.32 · 51%
- Practice expense (office) RVU5.11 · 36%
- Malpractice RVU1.84 · 13%
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.
36835 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
Code 36825 describes an AV graft made with autogenous material; 36835 describes an external Thomas shunt.
No office rate
Code 36830 describes an AV graft made with nonautologous material. It is not the code for insertion of a Thomas external shunt.
Compare 36835 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
$513.01
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$477.11
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36835 billing questions
How is 36835 different from an AV fistula code such as 36821?
Use 36835 for insertion of a Thomas external shunt with cannulae and external tubing. Code 36821 describes creation of a direct internal artery-to-vein fistula.
How does a Thomas shunt differ from a dialysis graft?
A Thomas shunt is an external access. Codes 36825 and 36830 describe creation of an AV graft, using autogenous or nonautologous material, respectively.
Does this code describe isolated cannula placement?
The defining service is operative insertion of the Thomas external shunt. If the documentation describes only cannulation or work on an existing access, it does not establish that this shunt-insertion service was performed.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Which modifiers or additional surgeon claims are appropriate?
Modifier 50 is inappropriate for this procedure. Assistant-at-surgery services are restricted from payment, and co-surgeons and team surgery are 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.
4,55336831,,Open thrombect av fistula,A,,10.73,3.46,NA,3.46,,2.75,16.94,16.94,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,55436832,,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