CPT 36226 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Cardiovascular System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 50 - Bilateral Procedure • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 36226 |
National average reimbursement for CPT 36226 by major payers:
$2,029.93
$2,569.92
$2,839.72
$3,083.16
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 36226 | ||||||
United | 36226 | $12015.05 | 1598826729 - MARIE-LOUISE DAGUILH | 131740114 - MONTEFIORE MEDICAL CENTER | NY | Family Medicine Physician (207Q00000X) |
United | 36226 | $1503.06 | 1326014655 - AMY REISING | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 36226 | $2184.19 | 1447202338 - ROY CHUCK | 131740114 - MONTEFIORE MEDICAL CENTER | NY | Ophthalmology Physician (207W00000X) |
United | 36226 | $2184.19 | 1376628768 - CHANDRAPPA BALIKAI | 131740114 - MONTEFIORE MEDICAL CENTER | NY | Anesthesiology Physician (207L00000X) |
United | 36226 | $12015.05 | 1376628768 - CHANDRAPPA BALIKAI | 131740114 - MONTEFIORE MEDICAL CENTER | NY | Anesthesiology Physician (207L00000X) |
United | 36226 | $909.33 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 36226 | $14835.58 | 1730102351 - SUSMITA PATI | 112571524 - (NY) STONY BROOK CHILDRENS SERVICE UNIVERSITY FACULTY PRACTICE CORP | NY | Pediatrics Physician (208000000X) |
United | 36226 | $2184.19 | 1598826729 - MARIE-LOUISE DAGUILH | 131740114 - MONTEFIORE MEDICAL CENTER | NY | Family Medicine Physician (207Q00000X) |
United | 36226 | $2184.19 | 1457746463 - JOHN FUTCHKO | 131740114 - MONTEFIORE MEDICAL CENTER | NY | Vascular Surgery Physician (2086S0129X) |
United | 36226 | $4214.52 | 1710057369 - KAREN MARDER | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Neurology Physician (2084N0400X) |
United | 36226 | $12129.00 | 1861650780 - CHILDRENS NATIONAL MEDICAL CENTER | 530196580 - CHILDRENS HOSPITAL | DC | Children's Hospital (282NC2000X) |
United | 36226 | $4040.83 | 1811000177 - CHARLESTON RADIOLOGISTS PA | 570634747 - CHARLESTON RADIOLOGISTS, P.A. | SC | Diagnostic Radiology Physician (2085R0202X) |
United | 36226 | $2184.19 | 1790043800 - JUSTIN KOPA | 131740114 - MONTEFIORE MEDICAL CENTER | NY | Pediatrics Physician (208000000X) |
United | 36226 | $5160.38 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 36226 | $14835.58 | 1730325721 - THELMA GAETANO | 112571524 - (NY) STONY BROOK CHILDRENS SERVICE UNIVERSITY FACULTY PRACTICE CORP | NY | Pediatrics Physician (208000000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 36226 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 36226 code is part of the Surgery services used for Surgical Procedures on the Cardiovascular System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 36226 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 36222-CPT | High | Selective Catheter Placement Common Carotid Or Innominate Artery Unilateral Any Approach With Angiography Of The Ipsilateral Extracranial Ca- Rotid Circulation And All Associated Radiological Supervision And Interpretation Includes Angiogra-Phy Of The Cervicocerebral Arch When Performed |
| 36223-CPT | High | Selective Catheter Placement Common Carotid Or Innominate Artery Unilateral Any Approach With Angiography Of The Ipsilateral Intracranial Ca- Rotid Circulation And All Associated Radiological Supervision And Interpretation Includes Angiogra-Phy Of The Extracranial Carotid And Cervicocere- Bral Arch When Performed |
| 36224-CPT | High | Selective Catheter Placement Internal Carotid Artery Unilateral With Angiography Of The Ipsilateral Intracranial Carotid Circulation And All Associated Radiological Supervision And Interpretation Includes Angiography Of The Extracranial Carotid And Cervicocerebral Arch When Performed |
| 36226-CPT | High | Selective Catheter Placement Vertebral Artery Unilateral With Angiography Of The Ipsilateral Vertebral Circulation And All Associated Radio- Logical Supervision And Interpretation Includes Angiography Of The Cervicocerebral Arch When Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 36226. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 36226 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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