CPT 36904 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 | • 24 - Ambulatory Surgical Center • 21 - Inpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 36904 |
National average reimbursement for CPT 36904 by major payers:
$2,074.01
$2,509.41
$2,606.66
$2,882.60
| 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 36904 | ||||||
United | 36904 | $3000.00 | 1497220412 - PROVIDENCE INTERVENTIONAL ASSOCIATES II LLC, PROVIDENCE ACCESS CARE | 453631706 - (RI) PROVIDENCE INTERVENTIONAL ASSOCIATES II LLC | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36904 | $11291.00 | 1073009304 - SUSITNA SURGERY CENTER LLC | 472934701 - (AK) SUSITNA SURGERY CENTER LLC | AK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36904 | $2549.00 | 1093088999 - CHIPPENHAM AMBULATORY SURGERY CENTER, LLC | 371587067 - (VA) CHIPPENHAM AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36904 | $3108.00 | 1952535502 - PLATEAU SURGERY CENTER | 264769256 - (TN) PLATEAU SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36904 | $3350.00 | 1497788277 - PACIFIC EYE SURGERY CENTER, PACIFIC SURGERY CENTER | 954200314 - (CA) PACIFIC EYE SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36904 | $3500.00 | 1922003052 - EAST OREGON SURGERY CENTER, LLC | 200209992 - (OR) EAST OREGON SUREGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36904 | $3870.00 | 1912627712 - CENTER FOR ROBOTIC SURGERY OF LOUISIANA LLC | 883537315 - CENTER FOR ROBOTIC SURGERY OF LOUISIANA LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36904 | $4368.00 | 1558782268 - HOUSTON SURGERY CENTER | 464007273 - (TX) HOUSTON SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36904 | $1496.55 | 1043264864 - WARREN ANDERSON | 350593390 - DEACONESS HOSPITAL INC | LA | Specialist (174400000X) |
United | 36904 | $3826.00 | 1417566217 - CLEARWAY SURGERY CENTER OF EASTON, LLC | 851826166 - (MD) CLEARWAY SURGERY CENTER OF EASTON LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36904 | $6365.00 | 1730175159 - CHARLOTTE ENDOSCOPIC SURGERY CENTER LLC, CHARLOTTE SURGERY CENTER | 651071112 - (FL) CHARLOTTE ENDOSCOPIC SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36904 | $3257.19 | 1467853929 - SALIL SHAH | 350593390 - DEACONESS HOSPITAL INC | FL | Internal Medicine Physician (207R00000X) |
United | 36904 | $1400.00 | 1245566744 - CHESTERFIELD ASC, LLC | 811166184 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 36904 | $1612.88 | 1093198350 - RIVERSIDE EYE CENTER PLLC, RIVERSIDE EYE CENTER | 473000492 | FL | Multi-Specialty Group (193200000X) |
United | 36904 | $900.00 | 1457640112 - MID-MICHIGAN ENDOSCOPY CENTER, PLLC, CHARTER ENDOSCOPY CENTER | 201979186 - (MI) MID MICHIGAN ENDOSCOPY CENTER | MI | 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 36904 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 36904 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 36904 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 |
|---|---|---|
| 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; |
| 36902-CPT | High | 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; With Transluminal Balloon Angi- |
| 36903-CPT | High | 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; With Transcatheter Placement Of |
| 36904-CPT | High | Percutaneous Transluminal Mechanical Thrombectomy And/Or Infusion For Thrombolysis Dialysis Circuitany Method Including All Imaging And Radiologicalsupervision And Interpretation Diagnostic Angi- Ography Fluoroscopic Guidance Catheter Place- Ment(S) And Intraprocedural Pharmacological Throm-Bolytic Injection(S); |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 36904. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 36904 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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