Billing code 36640: Arterial cannulationMedicare rate & RVUs in Missouri
Reports arterial catheter placement or cannulation for extracorporeal circulation or standby access, such as arterial access established for cardiopulmonary bypass.
CMS doesn’t publish an office rate for 36640 in Missouri.
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 36640 covers
This code covers arterial catheter placement or cannulation when the access is for extracorporeal circulation or standby use. A surgeon or other physician may establish the arterial access in an operating room for a procedure such as cardiopulmonary bypass. It is distinct from placing a routine arterial line solely for blood sampling or hemodynamic monitoring.
Report the code when the documented purpose of the arterial access supports extracorporeal circulation or standby use; record the indication and catheterization performed. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are 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 36640 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City | Unavailable | $99.07 |
| Metropolitan St. Louis | Unavailable | $99.55 |
| Rest Of Missouri | Unavailable | $96.92 |
How the 36640 rate is calculated
Each of 36640’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 · 36640
RVUs × geographic indexes × conversion factor
Work2.05
2.05 RVUs× 1.000 GPCI
Practice expense0.83
0.83 RVUs× 1.000 GPCI
Malpractice0.14
0.14 RVUs× 1.000 GPCI
Adjusted RVUs
3.0200
Conversion factor
$33.4009
Medicare rate
$100.87
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 36640
The CMS indicators that decide how 36640 is paid alongside other services.
CMS payment indicators · 36640
Arterial cannulation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
36640 without 51 · national facility
$100.87
Arterial cannulation
36640-51 · Second procedure: 50%
$50.44
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%).
36640 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 36620Arterial catheter
- Choose 36620 for percutaneous arterial catheterization for sampling, monitoring, or transfusion. Choose 36640 when arterial access is for extracorporeal circulation or standby.
- 36625Arterial catheter
- Code 36625 describes arterial catheterization by cutdown for sampling, monitoring, or transfusion. The purpose of access, not simply the presence of an arterial catheter, distinguishes it from 36640.
- 36600Arterial blood draw
- Code 36600 is for arterial puncture to obtain a blood sample. It does not describe placement or cannulation of an arterial catheter for extracorporeal circulation or standby.
36640 billing questions
How is this different from 36620?
Use 36640 for arterial access intended for extracorporeal circulation or standby use. Code 36620 describes percutaneous arterial catheterization for sampling, monitoring, or transfusion.
Can a one-time arterial blood draw be reported with this code?
No. A single arterial puncture to withdraw blood is represented by 36600; 36640 concerns arterial catheter placement or cannulation for extracorporeal circulation or standby.
What documentation supports reporting 36640?
Document the reason for arterial access and the catheterization or cannulation performed. The record should show its role in extracorporeal circulation or standby use, rather than routine arterial-line monitoring alone.
Can modifier 50 be used if access is placed on both sides?
No. CMS identifies bilateral adjustment as inapplicable for this code; the descriptor or anatomy makes modifier 50 inappropriate.
How does Medicare handle this code with other procedures in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. The code has a 0-day global period, which includes same-day preoperative and postoperative care.
Can an assistant, co-surgeon, or surgical team also be paid for this service?
Medicare does not pay an assistant at surgery for this code. 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 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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