Billing code 36836: AV fistula creationMedicare rate & RVUs in Texas
Report this service when a clinician creates hemodialysis access percutaneously between an artery and vein in an upper extremity through one access site.
Medicare pays $7,331.71–$8,479.78 for 36836 in the office in Texas, from Beaumont to Austin. Which amount applies depends on the service address.
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 36836 covers
This service establishes a native arteriovenous connection in an upper extremity for hemodialysis using a percutaneous, catheter-based approach rather than an open surgical anastomosis. Vascular surgeons and interventional specialists typically perform it in a hospital or outpatient setting. The code represents creation through a single access site, not a surgical fistula made through an open incision or an arteriovenous graft.
Report one unit for the single access-site service. When another separate access site is used to create an additional fistula, report add-on code 36837 with 36836. The operative report should identify the limb, artery and vein, percutaneous approach, and access-site count. The 0-day global period includes same-day preoperative and postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team-surgery payment 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 36836 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 payment localities
$7331.71 to $8479.78
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $8,479.78 | $312.78 |
| Beaumont | $7,331.71 | $307.16 |
| Brazoria | $7,957.35 | $307.54 |
| Dallas | $7,999.09 | $310.68 |
| Fort Worth | $7,921.89 | $310.68 |
| Galveston | $7,974.53 | $309.28 |
| Houston | $7,993.38 | $328.13 |
| Rest Of Texas | $7,633.61 | $308.01 |
How the 36836 rate is calculated
Each of 36836’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 · 36836
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.02Practice expense 232.45Malpractice 1.03
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 36836
The CMS indicators that decide how 36836 is paid alongside other services.
CMS payment indicators · 36836
AV fistula creation
| 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) | 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
36836 without 51 · national office
$8,032.92
AV fistula creation
36836-51 · Second procedure: 50%
$4,016.46
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%).
36836 compared with similar codes
Compare codes
36836 vs 36837 vs 36821 vs 36818 vs 36825: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 36837AV fistula creation
- 36836 represents the initial single access site. Use 36837 for each additional separate access site in the same percutaneous fistula-creation service.
- 36821Dialysis access
- 36821 is an open direct fistula-creation service; 36836 is the percutaneous approach.
- 36818AV fistula creation
- 36818 describes open upper-arm fistula creation using the cephalic vein. Choose 36836 when the fistula is created percutaneously.
- 36825Dialysis access
- 36825 creates access with an autogenous graft. 36836 creates a direct artery-to-vein connection percutaneously.
36836 billing questions
How is 36836 different from open fistula creation?
36836 describes percutaneous creation of the upper-extremity arteriovenous connection. Open surgical fistula codes, such as 36821, describe a different approach.
How is an additional access site reported?
Report 36837 with 36836 for each additional separate access site used to create a fistula.
Can modifier 50 be used for bilateral fistula creation?
No. Modifier 50 is inappropriate for 36836.
What documentation supports 36836?
Document the percutaneous technique, the artery and vein connected, the upper-extremity site, and the number of access sites used.
What same-day care is included?
The 0-day global period includes preoperative and postoperative care on the procedure date.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the session are subject to the standard multiple-procedure reduction.
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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