CPT 36420 Fee Schedule
Last Updated: June 2025
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 – Hospital |
| Common Modifiers | • None • 79 - Unrelated procedure or service by same physician during postoperative period • GC - Service has been performed in part by a resident under the direction of a teaching physician |
| Complexity Level | Moderate |
National average reimbursement for CPT 36420 by major payers:
$65.34
$69.26
$70.39
$79.57
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.
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.
| CPT Code | Complexity Level | Description |
|---|---|---|
| 36400 | 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 | 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 | 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 | Low | Venipuncture Cutdown Under Age 1 |
See what providers are getting paid in 2025 for 36420:
CPT 36420 Fee Schedule & Reimbursement Rates
The CPT 36420 fee schedule varies by payer type. Below are Medicare rates for 2025 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. Cigna National Rate | More Info |
|---|---|---|---|
| 36400 | $27.30 | $44.70 | |
| 36405 | $23.97 | $40.07 | |
| 36406 | $17.64 | $29.52 | |
| 36410 | $17.64 | $28.76 | |
| 36420 | $46.94 | $79.57 | |
| 36425 | $38.95 | $66.81 |
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is price transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). In short, this regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
Healthcare Price Transparency Rule
cms.govConsumer Guide To Healthcare Prices
aha.orgGlossary of Healthcare Terms
healthcare.govUnlock access to price transparency insights today.
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