No office rate
36821 establishes a direct arteriovenous access. Use 37607 for an existing access that is being closed or have its flow reduced.
On this page
CMS RVU26D · Effective 2026-10-01
37607 Access fistula procedure Medicare reimbursement rates in Tennessee
Reports surgical closure or flow reduction of an existing dialysis-access arteriovenous fistula, commonly for access-related hand ischemia or excessive shunting. Compare 37607 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 37607 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
No supported rate
Facility setting
$314.67
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 37607: Arteriovenous access fistula ligation or banding
Reports surgical closure or flow reduction of an existing dialysis-access arteriovenous fistula, commonly for access-related hand ischemia or excessive shunting.
A vascular surgeon ligates an existing arteriovenous access fistula to stop its flow or places a band to reduce flow while preserving access. Typical situations include access-related hand ischemia or excessive shunting that contributes to cardiac strain. The service is performed in an operative setting; the operative note should identify the access and explain whether it was closed or flow-reduced and why intervention was needed.
This is a major surgery with 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 multiple-procedure reduction. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 37607
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.09 · 59%
- Practice expense (office) RVU2.79 · 27%
- Malpractice RVU1.48 · 14%
6.9K
Medicare services in 2024 · #1673 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.
37607 compared with similar codes
Office rates for Tennessee, from the same CMS release.
No office rate
36832 describes revision of an existing fistula. Choose 37607 when the documented procedure instead ligates the access or reduces its flow by banding.
No office rate
36833 is for fistula revision with thrombectomy. It is distinct from 37607, which addresses closure or flow reduction rather than clot removal with revision.
Compare 37607 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
Unavailable
Facility
$314.67
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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 37607 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
4,675
- Code
- 37607
- Physician work
- 6.09
- Practice expense
- 2.79
- Malpractice
- 1.48
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.09 | × 1.000 | 6.0900 |
| Practice expense | 2.79 | × 0.909 | 2.5361 |
| Malpractice | 1.48 | × 0.537 | 0.7948 |
| Total RVUs | 9.4209 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Tennessee$314.67
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.09 | 1 |
| Practice expense | 2.79 | 0.909 |
| Malpractice | 1.48 | 0.537 |
(6.09 × 1 + 2.79 × 0.909 + 1.48 × 0.537) × $33.4009 = $314.67
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.
37607 billing questions
When should this code be chosen over an access revision code?
Use 37607 when the operative goal is to close the existing fistula or reduce its flow with banding. A revision code describes a different operation intended to revise or salvage the access.
Can modifier 50 be used when a patient has access fistulas on both sides?
No. The CMS facts specify that bilateral adjustment does not apply and modifier 50 is inappropriate for this service.
What documentation supports reporting 37607?
Document the fistula treated, the clinical reason for intervention, and the operative method and result, such as closure or flow reduction by banding.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and related postoperative care for 90 days are included in the global period. The period begins with the surgery.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are reduced when performed in the same session.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery, and team surgery is not permitted. Co-surgeons are paid only when supporting documentation is provided.
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.
4,67237600,,Ligation xtrnl carotid art,A,,12.11,5.59,NA,5.59,,2.13,19.83,19.83,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,67337605,,Ligation int/com carotid art,A,,13.92,2.74,NA,2.74,,3.56,20.22,20.22,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,67437606,,Lig int/com carotid art occl,A,,8.59,10.54,NA,10.54,,3.61,22.74,22.74,0,090,0.09,0.84,0.07,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,67537607,,Lig/banding angioacs av fstl,A,,6.09,2.79,NA,2.79,,1.48,10.36,10.36,0,090,0.09,0.84,0.07,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,67637609,,Ligation/bx temporal artery,A,,2.97,5.83,,2.01,,0.65,9.45,5.63,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,6773760F,,Pt w/dysphag/wt loss/nutr,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4,67837615,,Ligation major artery neck,A,,7.61,4.81,NA,4.81,,1.43,13.85,13.85,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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