CPT 36838 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 36838 |
National average reimbursement for CPT 36838 by major payers:
$1,508.77
$1,610.64
$1,657.63
$1,876.08
| 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 36838 | ||||||
United | 36838 | $1843.00 | 1154449643 - AUGUSTA EYE SURGERY, LLC | 205644814 - (GA) AUGUSTA EYE SURGERY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $3072.00 | 1518280684 - NORTHWEST SURGERY CENTER, INC. | 364663721 - (CA) NORTHWEST SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $6588.00 | 1841231792 - NORTH HAVEN SURGERY CENTER LLC, NORTH HAVEN PAIN MEDICINE CENTER, LLC | 770656233 - (CT) NORTH HAVEN SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $2800.00 | 1598858714 - MISSION VALLEY HEGIHTS SURGERY CENTER, MISSION VALLEY OUTPATIENT SURGERY CENTER | 261158246 - (CA) POWAY CA MULTI-SPECIALTY ASC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $6365.00 | 1952814386 - ADVANCED SURGICAL CARE OF BOERNE, LLC | 821680961 - (TX) ADVANCED SURGICAL CARE OF BOERNE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $7415.00 | 1194255372 - DECATUR UROLOGY SURGERY CENTER | 814721108 - (GA) DECATUR UROLOGY SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $3200.00 | 1023373628 - EYES ON STARK SURGERY CENTER, LLC, VISTA SURGICAL CENTER | 451114025 - (OH) EYES ON STARK SURGERY CENTER, LLC DBA VISTA SURGICAL CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $1342.00 | 1194718312 - CAPE COD ASC LLC | 43424805 - (MA) CAPE COD ASSOC LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $3515.00 | 1699054098 - SURGCENTER OF WESTERN MARYLAND, LLC | 272969860 - (MD) SURGCENTER OF WESTERN MARYLAND, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $4170.00 | 1285283432 - JONESBORO AMBULATORY SURGERY CENTER, LLC | 832479059 - (AR) JONESBORO AMBULATORY SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $2564.00 | 1386892230 - NORMAN ENDOSCOPY CENTER, LLC | 208716173 - (OK) NORMAN ENDOSCOPY CENTER LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $7326.00 | 1538316278 - PHYSICIANS' SURGERY CENTER OF DOWNEY, LLC | 205170962 - (CA) PHYSICIANS SURGERY CENTER OF | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $2000.00 | 1982186425 - CENTER FOR SPINE & PAIN MEDICINE PC, CSPM GSV ASC | 341976829 - CENTER FOR SPINE AND PAIN MEDICI | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $3800.00 | 1447225503 - BAPTIST DESOTO SURGERY CENTER, LP | 200804946 - (MS) BAPTIST DESOTO SURGERY CENTER LP | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36838 | $3000.00 | 1023151974 - DEL MAR SURGERY CENTER | 330869192 - (CA) DEL MAR SURGERY CENTER | CA | 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 36838 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 36838 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 36838 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 |
|---|---|---|
| 36836-CPT | High | Percutaneous Arteriovenous Fistula Creation, Upper Extremity, Single Access Of Both The Peripheral Artery And Peripheral Vein, Including Fistula Maturation Procedures (Eg, Transluminal Balloon Angioplasty, Coil Embolization) When Performed, Including All Vascular Access, Imaging Guidance And Radiologic Supervision And Interpretation |
| 36837-CPT | High | Percutaneous Arteriovenous Fistula Creation, Upper Extremity, Separate Access Sites Of The Peripheral Artery And Peripheral Vein, Including Fistula Maturation Procedures (Eg, Transluminal Balloon Angioplasty, Coil Embolization) When Performed, Including All Vascular Access, Imaging Guidance And Radiologic Supervision And Interpretation |
| 36838-CPT | High | Distal Revascularization And Interval Ligation (Dril), Upper Extremity Hemodialysis Access (Steal Syndrome) |
| 36901-CPT | Moderate | Introduction Of Needle(S) And/Or Catheter(S) Di- Alysis Circuit With Diagnostic Angiography Of Thedialysis Circuit Including All Direct Puncture(S)And Catheter Placement(S) Injection(S) Of Con- Trast All Necessary Imaging From The Arterial Anastomosis And Adjacent Artery Through Entire Venous Outflow Including The Inferior Or Superior Vena Cava Fluoroscopic Guidance Radiological Supervision And Interpretation And Image Documen- Tation And Report; |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 36838. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 36838 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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