CPT 36420 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 | • 11 - Office • 21 - Inpatient Hospital • 23 - Emergency Room |
| Common Modifiers | • None • 79 - Unrelated procedure - postop period • GC - Service performed by resident under supervision |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 36420 |
National average reimbursement for CPT 36420 by major payers:
$65.34
$69.26
$70.39
$79.57
| 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 36420 | ||||||
United | 36420 | $350.00 | 1265431670 - AUBURN SURGERY CENTER INC. | 431937843 - (MO) AUBURN SURGERY CENTER INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $150.00 | 1770588584 - PHYSICIANS SURGERY CENTER LLC, NATIONAL SPINE & ORTHO SURGERY CENTER OF FT. MYERS | 592924183 - (FL) PHYSICIANS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $253.00 | 1639164916 - THE SURGERY CENTER AT SACRED HEART MEDICAL PARK, DESTIN, LLC | 562315052 - (FL) THE SURGERY CENTER AT SACRED HEART MEDICAL PARK DESTIN LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $330.00 | 1992700090 - TAMPA BAY SPECIALTY SURGERY CENTER LLC, TAMPA BAY SPECIALTY SURGERY CENTER | 331019420 - (FL) TAMPA BAY SPECIALTY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $152.00 | 1952368482 - SAN DIEGO ENDOSCOPY CENTER | 770322251 - (CA) SAN DIEGO ENDOSCOPY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $131.00 | 1285630160 - NOVAMED EYE SURGERY CENTER OF NORTH COUNTY, LLC, WOODCREST SURGERY CENTER | 364111316 - (MO) NOVAMED EYE SURGERY CENTER OF NORTH COUNTY LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $106.00 | 1851317614 - KENDALL POINTE SURGERY CENTER LLC | 364236445 - (IL) KENDALL POINTE SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $140.00 | 1902864879 - SPOKANE SURGERY CENTER LTD PS | 911336886 - (WA) SPOKANE SURGERY CENTER LTD | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $91.00 | 1396733945 - EYE LASER & SURGERY CENTER OF COLUMBUS, LLC | 640942234 - (MS) EYE LASER SURGERY CENTER OF COLUMBUS LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $104.00 | 1780699546 - CASCADES ENDOSCOPY CENTER, LLC, WHITEMARSH ENDOSCOPY CENTER | 203496335 - (MD) CASCADES ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $1047.00 | 1528335148 - SHRINERS HOSPITALS FOR CHILDREN, SHRINERS HOSPITALS FOR CHILDREN - ERIE AMBULATORY SURGERY CENTER | 362193608 - SHRINERS HOSPITALS FOR CHILDREN | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $312.00 | 1275700957 - PACIFIC CATARACT AND LASER INSTITUTE INC PC | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $152.00 | 1740394741 - YAMHILL VALLEY SURGICAL CENTER INC. | 931315470 | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $1675.00 | 1750553376 - SAN MATEO SURGERY CENTER LLC | 510655329 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36420 | $1344.00 | 1043297872 - CENTRAL JERSEY AMBULATORY SURGICAL CENTER, LLC | 223669777 - (NJ) CENTRAL JERSEY AMBULATORY SURGICAL CENTER LLC | NJ | 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 36420 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 36420 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 36420 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 |
|---|---|---|
| 36400-CPT | Low | Venipuncture Younger Than Age 3 Years Necessi- Tating The Skill Of A Physician Or Other Qualifiedhealth Care Professional Not To Be Used For Routine Venipuncture; Femoral Or Jugular Vein (Revised 1/1/2013) |
| 36405-CPT | Low | Venipuncture Younger Than Age 3 Years Necessi Tating The Skill Of A Physician Or Other Qualified Health Care Professional Not To Be Usedfor Routine Venipuncture; Scalp Vein (Revised 1/1/2013) |
| 36406-CPT | Low | Venipuncture Younger Than Age 3 Years Necessi- Tating The Skill Of A Physician Or Other Qualifiedhealth Care Professional Not To Be Used For For Routine Venipuncture; Other Vein (Rvsd 1/1/13) |
| 36420-CPT | Low | Venipuncture Cutdown Under Age 1 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 36420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 36420 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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