No office rate
Both describe upper-arm AV access, but 36818 uses the cephalic vein; 36819 uses basilic vein transposition.
On this page
CMS RVU26D · Effective 2026-10-01
36819 Dialysis access Medicare reimbursement rates in Wyoming
Reports open creation of an upper-arm hemodialysis access by transposing the basilic vein and connecting it to an artery. Compare 36819 office and facility rates across CMS payment localities in Wyoming.
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 36819 in Wyoming?
Wyoming 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
No supported rate
Facility setting
$634.93
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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.
Vascular surgery
About 36819: Upper-arm basilic vein fistula creation
Reports open creation of an upper-arm hemodialysis access by transposing the basilic vein and connecting it to an artery.
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.
CMS billing rules for 36819
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU12.96 · 65%
- Practice expense (office) RVU3.60 · 18%
- Malpractice RVU3.31 · 17%
4.4K
Medicare services in 2024 · #1957 by national volume
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.
36819 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
Choose 36819 when upper-arm access is created by transposing the basilic vein. Code 36821 describes a direct open anastomosis without that method.
No office rate
Code 36819 uses the patient's transposed basilic vein. Code 36825 describes access created with an autogenous graft.
No office rate
Code 36820 describes open access using a forearm vein; 36819 is specific to upper-arm basilic vein transposition.
Compare 36819 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
Wyoming** →
Office / nonfacility
Unavailable
Facility
$634.93
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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 36819 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
4,547
- Code
- 36819
- Physician work
- 12.96
- Practice expense
- 3.60
- Malpractice
- 3.31
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.96 | × 1.000 | 12.9600 |
| Practice expense | 3.60 | × 1.000 | 3.6000 |
| Malpractice | 3.31 | × 0.740 | 2.4494 |
| Total RVUs | 19.0094 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$634.93
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.96 | 1 |
| Practice expense | 3.6 | 1 |
| Malpractice | 3.31 | 0.74 |
(12.96 × 1 + 3.6 × 1 + 3.31 × 0.74) × $33.4009 = $634.93
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.
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 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.
4,54436810,,Insertion of cannula,A,,3.86,1.11,NA,1.11,,0.34,5.31,5.31,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54536815,,Insertion of cannula,A,,2.55,0.50,NA,0.50,,0.64,3.69,3.69,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54636818,,Av fuse uppr arm cephalic,A,,12.08,3.69,NA,3.69,,3.05,18.82,18.82,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54736819,,Av fuse uppr arm basilic,A,,12.96,3.60,NA,3.60,,3.31,19.87,19.87,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54836820,,Av fusion/forearm vein,A,,12.74,3.89,NA,3.89,,3.24,19.87,19.87,0,090,0.09,0.84,0.07,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,54936821,,Av fusion direct any site,A,,11.60,3.44,NA,3.44,,2.95,17.99,17.99,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4,55036823,,Insertion of cannula(s),A,,22.41,11.02,NA,11.02,,6.00,39.43,39.43,0,090,0.09,0.84,0.07,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,