Billing code 36819: Dialysis accessMedicare rate & RVUs in Washington
Reports open creation of an upper-arm hemodialysis access by transposing the basilic vein and connecting it to an artery.
CMS doesn’t publish an office rate for 36819 in Washington.
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 36819 covers
The surgeon mobilizes the basilic vein in the upper arm, brings it into a more superficial position for dialysis cannulation, and creates an artery-to-vein connection. Vascular surgeons typically perform this operation in an operating room for patients who need a durable hemodialysis access. The operative approach may involve one or more stages, so the documented work should establish that the access is created by upper-arm basilic vein transposition.
Select this code for the basilic-vein transposition method, not simply because an upper-arm fistula is created. The operative report should identify the vein, the upper-arm site, the transposition, and the arterial connection. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related 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 for this anatomy. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery 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 36819 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $649.25 |
| Seattle (King Cnty) | Unavailable | $692.38 |
How the 36819 rate is calculated
Each of 36819’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 · 36819
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.96Practice expense 3.60Malpractice 3.31
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 36819
36819 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 36819
Dialysis access
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 36819
Dialysis access
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
36819 without 51 · national facility
$663.68
Dialysis access
36819-51 · Second procedure: 50%
$331.84
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%).
36819 compared with similar codes
Compare codes
36819 vs 36818 vs 36821 vs 36825 vs 36820: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 36818AV fistula creation
- Both describe upper-arm AV access, but 36818 uses the cephalic vein; 36819 uses basilic vein transposition.
- 36821Dialysis access
- Choose 36819 when upper-arm access is created by transposing the basilic vein. Code 36821 describes a direct open anastomosis without that method.
- 36825Dialysis access
- Code 36819 uses the patient's transposed basilic vein. Code 36825 describes access created with an autogenous graft.
- 36820AV fistula
- Code 36820 describes open access using a forearm vein; 36819 is specific to upper-arm basilic vein transposition.
36819 billing questions
How is this different from code 36818?
This code describes upper-arm access created using basilic vein transposition. Code 36818 is the upper-arm cephalic-vein approach.
When would code 36821 be more appropriate?
Use 36821 for an open direct artery-to-vein anastomosis when the service is not performed by upper-arm basilic vein transposition.
Is the postoperative access care separately reported during the global period?
Related postoperative care during the 90-day global period is included. The global period also includes the day-before preoperative visit.
Should modifier 50 be added for bilateral access?
No. Modifier 50 is inappropriate for this code's descriptor and anatomy.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What documentation distinguishes this service from an AV graft?
Document that the patient's basilic vein was mobilized and transposed in the upper arm to create the arterial connection. Code 36825 describes access created with an autogenous graft instead.
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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