$7,310.46
Both describe percutaneous upper-extremity fistula creation. Choose 36837 for separate access sites and 36836 for the single-access approach.
On this page
CMS RVU26D · Effective 2026-10-01
36837 AV fistula creation Medicare reimbursement rates in Tennessee
Reports endovascular creation of an upper-extremity dialysis fistula using separate access sites, rather than the single-access approach described by its sibling code. Compare 36837 office and facility rates across CMS payment localities in Tennessee.
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 36837 in Tennessee?
Tennessee 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
$8275.34
1 of 1 localities have a supported rate.
Payment area: Tennessee
One mapped payment locality.
Facility setting
$374.39
1 of 1 localities have a supported rate.
Payment area: Tennessee
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.
Vascular surgery
About 36837: Percutaneous fistula creation through separate access sites
Reports endovascular creation of an upper-extremity dialysis fistula using separate access sites, rather than the single-access approach described by its sibling code.
This service creates an arteriovenous connection in an upper extremity through a catheter-based approach, using separate access sites to bring the target artery and vein together. It is performed by a vascular surgeon or other qualified procedural physician, typically in a hospital or ambulatory setting, to establish hemodialysis access. Imaging guidance, monitoring, and associated access and catheter work are part of the service when performed; they are not separate creation procedures.
Select this code when the documented percutaneous creation uses separate access sites; use the single-access sibling when that approach is documented. The operative report should identify the access sites and describe the artery-vein connection created. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 36837
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 RVU9.07 · 3%
- Practice expense (office) RVU261.75 · 96%
- Malpractice RVU1.41 · 1%
356
Medicare services in 2024 · #3836 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.
36837 compared with similar codes
Office rates for Tennessee, from the same CMS release.
No office rate
36821 describes open direct fistula creation. 36837 is for a percutaneous approach using separate access sites.
No office rate
36825 creates dialysis access with an autogenous graft; 36837 creates a fistula percutaneously without that graft approach.
No office rate
36830 uses a nonautogenous graft to create dialysis access. 36837 describes percutaneous fistula creation through separate access sites.
Compare 36837 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
Tennessee →
Office / nonfacility
$8275.34
Facility
$374.39
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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 36837 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
4,558
- Code
- 36837
- Physician work
- 9.07
- Practice expense
- 261.75
- Malpractice
- 1.41
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.07 | × 1.000 | 9.0700 |
| Practice expense | 261.75 | × 0.909 | 237.9308 |
| Malpractice | 1.41 | × 0.537 | 0.7572 |
| Total RVUs | 247.7579 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Tennessee$8275.34
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.07 | 1 |
| Practice expense | 261.75 | 0.909 |
| Malpractice | 1.41 | 0.537 |
(9.07 × 1 + 261.75 × 0.909 + 1.41 × 0.537) × $33.4009 = $8275.34
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.07 | 1 |
| Practice expense | 1.52 | 0.909 |
| Malpractice | 1.41 | 0.537 |
(9.07 × 1 + 1.52 × 0.909 + 1.41 × 0.537) × $33.4009 = $374.39
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.
36837 billing questions
How does 36837 differ from 36836?
36837 describes percutaneous fistula creation using separate access sites. 36836 is the related code for the single-access approach; follow the documented technique.
Can imaging guidance or catheter access be billed separately?
Imaging guidance, monitoring, and associated access and catheter work are included in the creation service when performed. Do not report them as separate parts of this same creation.
Should modifier 50 be appended for bilateral work?
No. CMS identifies bilateral adjustment as inapplicable to this code, and modifier 50 is inappropriate.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure. CMS applies the standard multiple-procedure reduction when other procedures are performed in the same session.
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.
4,55536833,,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
4,56036860,,External cannula declotting,A,,1.96,5.26,,0.47,,0.51,7.73,2.94,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,56136861,,Cannula declotting,A,,2.46,0.59,NA,0.59,,0.65,3.70,3.70,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780