Billing code 36455: Exchange transfusionMedicare rate & RVUs in Texas
Reports an exchange transfusion for a patient who is not a newborn, in which the patient’s blood is removed and replaced with donor blood.
CMS doesn’t publish an office rate for 36455 in Texas.
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 36455 covers
This service involves removing a patient’s blood while replacing it with donor blood as part of an exchange transfusion. It is distinct from a routine transfusion, which administers blood or blood components without exchanging the patient’s blood. Hematology, critical care, or other clinicians may perform the procedure in a hospital or another setting equipped to manage transfusion procedures. A common clinical context is exchange transfusion for a patient with sickle cell disease.
Report 36455 for an exchange transfusion in a patient who is not a newborn; use the newborn-specific codes when the patient and procedure meet those code descriptions. Documentation should identify the indication, the exchange performed, and the patient’s status as non-newborn. The code represents the exchange service, not a separate service for each portion of blood removed or infused. When other procedures are performed in the same session, CMS pays the highest-valued procedure in full and reduces the other procedures to 50% under the standard multiple procedure rule.
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 36455 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $113.03 |
| Beaumont | Unavailable | $111.45 |
| Brazoria | Unavailable | $110.39 |
| Dallas | Unavailable | $112.08 |
| Fort Worth | Unavailable | $112.19 |
| Galveston | Unavailable | $111.37 |
| Houston | Unavailable | $122.17 |
| Rest Of Texas | Unavailable | $111.54 |
How the 36455 rate is calculated
Each of 36455’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 · 36455
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.37Practice expense 0.46Malpractice 0.59
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 36455
The CMS indicators that decide how 36455 is paid alongside other services.
CMS payment indicators · 36455
Exchange transfusion
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| 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
36455 without 51 · national facility
$114.23
Exchange transfusion
36455-51 · Second procedure: 50%
$57.12
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%).
36455 compared with similar codes
Compare codes
36455 vs 36450 vs 36456 vs 36430 vs 36512: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 36450Exchange transfusion
- Use 36450 for exchange transfusion in a newborn; 36455 is the exchange transfusion code for patients other than newborns.
- 36456Blood exchange
- 36456 describes partial exchange transfusion for a newborn. 36455 is for an exchange transfusion in a non-newborn patient.
- 36430Blood transfusion
- 36430 is for a transfusion of blood or blood components, not an exchange of the patient’s blood.
- 36512Red cell apheresis
- 36512 describes therapeutic apheresis involving cell exchange. Select the code that matches the service and method performed, rather than using 36455 solely because blood is exchanged.
36455 billing questions
How is 36455 distinguished from 36450?
36455 is for exchange transfusion in a patient other than a newborn. Code 36450 is the newborn exchange transfusion code.
When is 36456 used instead?
36456 describes partial exchange transfusion for a newborn. It is not the code for a non-newborn exchange transfusion.
Is a routine blood transfusion reported with 36455?
A routine transfusion administers blood or components without exchanging the patient’s blood and is described by a different service. Report the procedure actually performed rather than treating an exchange as a routine transfusion.
How does CMS handle other procedures performed in the same session?
Under the standard multiple procedure reduction, CMS pays the highest-valued procedure in full and reduces the other procedures to 50%.
What documentation supports reporting 36455?
Document the clinical indication, that an exchange transfusion was performed, and that the patient was not a newborn. The record should distinguish the exchange from a routine transfusion.
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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