Billing code 36838: Access revascularizationMedicare rate & RVUs in Oregon
Reports an upper-extremity DRIL operation that restores hand perfusion compromised by hemodialysis access while preserving the access.
CMS doesn’t publish an office rate for 36838 in Oregon.
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 36838 covers
This operation treats hand ischemia associated with an upper-extremity hemodialysis access. The surgeon creates an arterial bypass to restore blood flow to the hand beyond the access and ligates the native artery between the access and the distal bypass connection. The approach is intended to relieve access-related diversion of blood while keeping the dialysis access usable. Vascular surgeons typically perform it in an operating room for patients with clinically significant access-related ischemia.
Report 36838 when the operative work includes the distal revascularization and interval ligation procedure; document the ischemic problem, its relationship to the access, and the bypass and ligation performed. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When performed bilaterally and reported with modifier 50, payment is at 150%. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is 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 36838 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $1,011.61 |
| Rest Of Oregon | Unavailable | $976.37 |
How the 36838 rate is calculated
Each of 36838’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 · 36838
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 21.15Practice expense 4.31Malpractice 5.39
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 36838
36838 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 36838
Access revascularization
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 36838
Access revascularization
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
36838 without 50 · national facility
$1,030.42
Access revascularization
36838-50 · Bilateral: 150%
$1,545.63
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
36838 compared with similar codes
Compare codes
36838 vs 36832 vs 36833 vs 36831: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 36832Fistula revision
- 36832 describes open revision of an AV fistula without thrombectomy. Choose 36838 when the operation instead performs the DRIL bypass and interval ligation for access-related hand ischemia.
- 36833Fistula revision
- 36833 is open AV fistula revision with thrombectomy. It does not describe the DRIL bypass and interval ligation that define 36838.
- 36831Fistula thrombectomy
- 36831 describes thrombectomy of an AV fistula without revision. Report 36838 for the access-related ischemia operation, not simply to describe clot removal.
36838 billing questions
When should 36838 be chosen over an AV fistula revision code?
Use 36838 when the surgeon performs the DRIL bypass and interval ligation to address access-related hand ischemia. Use a revision code when the documented operation is access revision rather than this revascularization procedure.
Is the bypass reported separately from 36838?
The bypass and interval ligation are the defining work of the DRIL procedure reported by 36838. The operative report should describe those steps rather than treating them as unrelated services.
What documentation supports reporting 36838?
Document the upper-extremity dialysis access, the access-related ischemic symptoms or findings, and the arterial bypass and interval ligation performed to restore distal perfusion.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. The global period applies to this major surgery.
Can 36838 be reported bilaterally?
When the procedure is performed on both sides, the CMS rule specifies modifier 50, with payment at 150%.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery 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 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
Fee sheets
Put 36838 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →