Billing code 36820: AV fistulaMedicare rate & RVUs in Washington
Open hemodialysis access creation using a transposed forearm vein, reported when the surgeon relocates the native vein and establishes an arterial connection.
CMS doesn’t publish an office rate for 36820 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 36820 covers
Code 36820 represents open creation of arteriovenous access using transposition of a native forearm vein. The surgeon mobilizes and repositions the vein to provide a usable superficial access route, then establishes the artery-to-vein connection. Vascular surgeons typically perform this operation in an operating room for a patient who needs durable hemodialysis access and whose anatomy supports use of a forearm vein.
Choose this code when the operative technique includes forearm vein transposition; a direct anastomosis without that transposition or an upper-arm vein transposition is coded differently. The operative report should identify the forearm vein and arterial connection, describe the transposition and anastomosis, and document the side. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% multiple-procedure reduction. Modifier 50 reports bilateral performance and is paid at 150%. Assistant-at-surgery services 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 36820 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $650.23 |
| Seattle (King Cnty) | Unavailable | $694.64 |
How the 36820 rate is calculated
Each of 36820’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 · 36820
RVUs × geographic indexes × conversion factor
Work12.74
12.74 RVUs× 1.000 GPCI
Practice expense3.89
3.89 RVUs× 1.000 GPCI
Malpractice3.24
3.24 RVUs× 1.000 GPCI
Adjusted RVUs
19.8700
Conversion factor
$33.4009
Medicare rate
$663.68
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 36820
36820 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 36820
AV fistula
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 36820
AV fistula
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 50 · payment effect
With and without the modifier
36820 without 50 · national facility
$663.68
AV fistula
36820-50 · Bilateral: 150%
$995.52
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
36820 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 36818AV fistula creation
- 36818 applies to upper-arm cephalic vein transposition. Code 36820 is for transposition of a forearm vein.
- 36819Dialysis access
- 36819 applies to upper-arm basilic vein transposition. Code 36820 describes forearm vein transposition.
- 36821Dialysis access
- 36821 is for a direct arteriovenous connection without forearm vein transposition; use 36820 when the forearm vein is transposed.
- 36825Dialysis access
- 36825 describes access created with an autogenous graft. Code 36820 uses a transposed native forearm vein.
36820 billing questions
How does 36820 differ from 36821?
Use 36820 when the surgeon transposes a forearm vein to create the access. Code 36821 describes a direct arteriovenous connection without the forearm vein transposition.
When is a graft code more appropriate?
Code 36820 describes access made with a transposed native forearm vein. A graft-based access is coded according to the graft material and technique, such as with 36825 or 36830.
What should the operative report document?
Document the forearm vein used, the transposition, the arterial connection, and the operative side. These details distinguish this procedure from a direct fistula or an upper-arm vein transposition.
Does the 90-day global period include related follow-up?
Yes. CMS includes the day-before preoperative visit and 90 days of related postoperative care in the global period.
How is bilateral performance reported?
Report bilateral performance with modifier 50. CMS pays the bilateral procedure at 150%.
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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