$26.92
Both describe skilled venipuncture in a child younger than 3 years, but 36400 identifies femoral or jugular access; 36405 identifies scalp access.
On this page
CMS RVU26D · Effective 2026-10-01
36405 Scalp venipuncture Medicare reimbursement rates in Vermont
Reports physician- or qualified health professional-performed scalp-vein venipuncture in a child younger than 3 years for specimen collection or therapeutic purposes. Compare 36405 office and facility rates across CMS payment localities in Vermont.
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 36405 in Vermont?
Vermont 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
$23.59
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$12.34
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Venipuncture
About 36405: Scalp-vein venipuncture in young child
Reports physician- or qualified health professional-performed scalp-vein venipuncture in a child younger than 3 years for specimen collection or therapeutic purposes.
This code represents venipuncture using a scalp vein in a child younger than 3 years when the procedure requires a physician’s or qualified health professional’s skill. It may be performed to obtain a blood specimen or for a therapeutic purpose, such as gaining venous access to administer treatment. The age and access site distinguish this service from other pediatric venipuncture codes.
Report the service when the documented procedure uses a scalp vein and the child is younger than 3 years; the record should support the site, age, and purpose. This code describes the venipuncture, not laboratory analysis of the specimen. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and the others at 50%.
CMS billing rules for 36405
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
Where the value comes from
- Work RVU0.30 · 42%
- Practice expense (office) RVU0.40 · 56%
- Malpractice RVU0.02 · 3%
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.
36405 compared with similar codes
Office rates for Vermont, from the same CMS release.
$18.09
Use 36406 for a different vein not specified by the pediatric site-specific codes. Use 36405 when the accessed vein is in the scalp.
$18.58
36410 is for physician- or qualified health professional-performed venipuncture in patients age 3 years or older; 36405 is for scalp access before age 3.
No office rate
36420 describes venous access by cutdown in a child younger than 1 year. 36405 describes venipuncture through a scalp vein, not cutdown access.
Compare 36405 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
Vermont →
Office / nonfacility
$23.59
Facility
$12.34
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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 36405 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
4,468
- Code
- 36405
- Physician work
- 0.30
- Practice expense
- 0.40
- Malpractice
- 0.02
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.30 | × 1.000 | 0.3000 |
| Practice expense | 0.40 | × 0.990 | 0.3960 |
| Malpractice | 0.02 | × 0.506 | 0.0101 |
| Total RVUs | 0.7061 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$23.59
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.3 | 1 |
| Practice expense | 0.4 | 0.99 |
| Malpractice | 0.02 | 0.506 |
(0.3 × 1 + 0.4 × 0.99 + 0.02 × 0.506) × $33.4009 = $23.59
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.3 | 1 |
| Practice expense | 0.06 | 0.99 |
| Malpractice | 0.02 | 0.506 |
(0.3 × 1 + 0.06 × 0.99 + 0.02 × 0.506) × $33.4009 = $12.34
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.
36405 billing questions
When should 36405 be chosen over 36400 or 36406?
Choose 36405 for a scalp vein in a child younger than 3 years. Codes 36400 and 36406 distinguish other venous sites in this age group.
Can 36405 be reported for routine blood collection?
Use it when the documented scalp-vein access in a child younger than 3 requires physician or qualified health professional skill. Routine venous collection is represented by 36415.
Does 36405 include testing the blood specimen?
No. It represents the venipuncture; laboratory analysis is a separate service when performed and reportable.
How does Medicare handle 36405 with other procedures in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the others at 50%.
What documentation supports reporting 36405?
Document the child's age, scalp-vein access, and whether the venipuncture was for specimen collection or a therapeutic purpose.
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.
4,46536262,,Removal of infusion pump,A,,4.01,4.38,NA,4.38,,1.08,9.47,9.47,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,46636299,,Unlisted px vascular njx,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
4,46736400,,Vnpnxr<3yrs phy/qhp fem/jug,A,,0.37,0.43,,0.08,,0.02,0.82,0.47,0,XXX,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,46836405,,Vnpnxr<3yrs phy/qhp scalp vn,A,,0.30,0.40,,0.06,,0.02,0.72,0.38,0,XXX,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,46936406,,Vnpnxr<3yrs phy/qhp other vn,A,,0.18,0.36,,0.04,,0.01,0.55,0.23,0,XXX,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,47036410,,Vnpnxr 3yr/> phy/qhp dx/ther,A,,0.18,0.37,,0.04,,0.02,0.57,0.24,0,XXX,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,47136415,,Coll venous bld venipuncture,X,,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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817