36904 Dialysis thrombectomy Medicare reimbursement rates in Washington

This service treats clot obstructing a hemodialysis access circuit, such as an arteriovenous fistula or graft, by mechanically removing clot, infusing thrombolytic medication, or using both approaches. An interventional radiologist, vascular surgeon, or appropriately trained nephrologist typically performs the intervention in an angiography suite or hospital procedure room. Access, catheter placement, and imaging used to guide and assess the circuit intervention are included in the service.

Choose 36904 when thrombectomy or thrombolysis is performed without peripheral-segment angioplasty or stent placement; those additional treatments change the code selection. Document the access circuit treated, the clot and intervention performed, and any additional treatment of peripheral or central segments. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur 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 dialysis-circuit service. Medicare does not pay an assistant at surgery under the stated statutory restriction; co-surgeon payment requires supporting documentation, and team surgery is not permitted.