CPT 36254 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 36254 |
National average reimbursement for CPT 36254 by major payers:
$2,648.47
$3,052.22
$2,947.09
$3,325.82
| 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 36254 | ||||||
United | 36254 | $1486.00 | 1174716708 - HENDERSON SURGERY CENTER | 208615920 - (NV) HENDERSON SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $2703.00 | 1548322829 - GASTROINTESTINAL MEDICAL CENTER | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $489.00 | 1609039056 - FARSHID PAYDAR MD PC, THE EYE CLINIC | 454779006 - (AZ) FARSHID PAYDAR MD PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $1410.00 | 1902834922 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $885.00 | 1609983477 - NORTH GEORGIA ENDOSCOPY CENTER INC | 582070246 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $840.00 | 1447457403 - BERGEN GASTROENTEROLOGY PC | 222713168 - (NJ) BERGEN GASTROENTEROLOGY, P.C. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $1389.00 | 1164646071 - ATLANTIC PLASTIC SURGERY ASSOCIATES PA | 20401481 - (NH) ATLANTIC PLASTIC SURGERY ASSOCIATES, P.A. | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $1378.00 | 1790167740 - TIDALHEALTH SURGERY CENTER, LLC | 474184623 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $1300.00 | 1003855594 - OHIO EYE ASSOCIATES, INC., OHIO EYE ASSOCIATES EYE SURGERY & LASER CENTER | 341171920 - (OH) OHIO EYE ASSOCIATES, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $4691.00 | 1033448782 - ENDOSCOPY SURGERY CENTER OF SILICON VALLEY LLC | 942909203 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $1409.00 | 1003875873 - WILDCREEK SURGERY CENTER | 880377689 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $1453.00 | 1043282775 - BALTIMORE ENDOSCOPY ASC LLC, GASTROINTESTINAL DIAGNOSTIC CENTER | 621760110 - (MD) BALTIMORE ENDOSCOPY ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $1465.00 | 1831846369 - OPHTHALMIC SURGERY CENTER, LLC | 874648478 - (KY) OPHTHALMIC SURGERY CENTER LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $1262.00 | 1255314662 - MAZZOCCO AMBULATORY SURGICAL CENTER | 954505995 - (CA) MAZZOCCO AMBULATORY SURGICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36254 | $1563.00 | 1083601298 - LAHAYE CENTER FOR ADVANCED EYE CARE, APMC, LAHAYE EYE CLINIC | 720988221 - (LA) LAHAYE EYE CLINIC, P.C. | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 36254 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 36254 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 36254 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 |
|---|---|---|
| 36245-CPT | High | Selective Catheter Placement, Arterial System; Each First Order Abdominal, Pelvic, Or Lower Extremity Artery Branch, Within A Vascular Family |
| 36246-CPT | High | Selective Catheter Placement, Arterial System; Initial Second Order Abdominal, Pelvic, Or Lower Extremity Artery Branch, Within A Vascular Family |
| 36251-CPT | High | Selective Catheter Placement (First-Order) Main Renal Artery And Any Accessory Renal Artery(S) Forrenal Angiography Including Arterial Puncture Andcatheter Placement(S) Fluorscopy Contrast Injection(S) Image Postprocessing Permanent Re- Cording Of Images And Radiological Supervision And Interpretation Including Pressure Gradient Measurements When Performed And Flush Aortogram When Performed; Unilateral |
| 36254-CPT | High | Superselective Catheter Placement (One Or More Second Order Or Higher Renal Artery Branches) Renal Artery And Any Accessory Renal Artery(S) For Renal Angiography Including Arterial Puncture Catheterization Fluoroscopy Contrast Injection(S) Image Postprocessing Permanent Recording Of Images And Radiological Supervision And Interpretation Including Pressure Gradient Measurements When Performed And Flush Aortogram 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 36254. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 36254 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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