CPT 36425 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 |
| Common Modifiers | • None • 59 - Distinct Procedural Service • RT - Right side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 36425 |
National average reimbursement for CPT 36425 by major payers:
$52.74
$55.25
$57.48
$66.81
| 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 36425 | ||||||
United | 36425 | $566.00 | 1346237328 - VICTORIA AMBULATORY SURGERY CENTER, LP, THE SURGERY CENTER | 352240144 - (TX) VICTORIA AMBULATORY SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $792.00 | 1922075167 - NORTH CENTRAL METHODIST ASC, LP, METHODIST AMBULATORY SURGERY CENTER NORTH CENTRAL | 742998447 - (TX) NORTH CENTRAL METHODIST ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $208.00 | 1689632119 - CHILDREN'S WEST SURGERY CENTER | 621872553 - (TN) CHILDRENS WEST SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $336.00 | 1033105960 - SURGERY CENTER OF OAK RIDGE, LLC, ADVANCED FAMILY SURGERY CENTER | 621801416 - (TN) ADVANCED FAMILY SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $75.00 | 1083624225 - UNIVERSITY OF MARYLAND SURGCIAL ASSOC PA, UNIVERSITY OF MARYLAND UROLOGICAL SURGERY CENTER | 521557551 - (MD) UNIVERSITY OF MARYLAND SURGICAL ASSOCIATES P A | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $531.00 | 1720530405 - GRAND RAPIDS SURGICAL SUITES LLC | 811321919 - (MI) GRAND RAPIDS SURGICAL SUITES, PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $566.00 | 1750499950 - MEDPLEX OUTPATIENT SURGERY CENTER LTD, MEDPLEX OUTPATIENT SURGERY CENTER | 760353620 - (AL) MEDPLEX OUTPATIENT SURGERY CENTER LTD | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $130.00 | 1740978386 - DUKE HEALTH INTEGRATED PRACTICE, INC, DUKE GI AT BRIER CREEK | 862109896 - DUKE HEALTH INTEGRATED PRACTICE INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $318.00 | 1295233658 - LEGENT OUTPATIENT SURGERY WESTOVER HILLS, LLC | 823717201 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $225.00 | 1386275147 - SURGERY CENTER OF MESA LLC | 813829555 - (AZ) SURGERY CENTER OF MESA LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $624.00 | 1649233180 - WEST PARK SURGERY CENTER, L.P., MEDICAL CITY SURGERY CENTER/MCKINNEY | 800002697 - (TX) WEST PARK SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $383.00 | 1992706840 - AMBULATORY SURGERY CENTER OF BURLEY, LLC | 820502971 - (ID) AMBULATORY SURGERY CENTER OF BURLEY LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $1251.00 | 1669895512 - AMBULATORY SURGICAL CENTER OF SOMERVILLE LLC, SOMERSET AMBULATORY SURGICAL CENTER | 371743209 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $1081.00 | 1558627406 - CARMEL SPECIALTY SURGERY CENTER LLC | 454729527 - (IN) CARMEL SPECIALTY SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36425 | $632.00 | 1427017987 - BAPTIST SURGERY CENTER LP, BAPTIST AMBULATORY SURGERY CENTER | 621672473 - (TN) BAPTIST SURGERY CENTER LP | TN | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 36425 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 36425 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 36425 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) |
| 36425-CPT | Low | Cutdown Venipuncture Age <1 Year |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 36425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 36425 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 36425) and we'll show you how you compare in 15 minutes or less.