Summary & Overview
CPT 36555: Pediatric Central Venous Access Catheter Insertion
CPT code 36555 captures the placement of a central venous access catheter in the neck, chest, or groin for patients younger than five years. This pediatric-specific procedural code is clinically important because it supports safe vascular access for blood sampling and delivery of medications, fluids, or parenteral nutrition in young children, a population with unique anatomic and anesthetic considerations. National stakeholders track utilization and coverage of this procedure for quality, safety, and cost-effectiveness concerns.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of billing context, expected sites of service, and payer coverage landscape. Readers will find benchmarks for utilization and reimbursement practices, discussion of pertinent policy updates affecting pediatric central line placement, and clinical context that clarifies when CPT code 36555 is typically reported. Where available, comparisons to related procedural codes and coding guidance are summarized to aid coding accuracy and administrative consistency.
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and comparative rate tables are noted where relevant.
Billing Code Overview
CPT code 36555 describes the insertion of a central venous access catheter in the neck, chest, or groin for a patient younger than five years of age. The procedure is performed to establish durable central venous access for drawing blood or for administration of medications, fluids, or nutrients.
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Service type: Insertion of a central venous access catheter for pediatric patients (<5 years)
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Typical site of service: Inpatient or outpatient surgical settings, pediatric interventional radiology, or pediatric operating rooms
Clinical & Coding Specifications
Clinical Context
A common scenario involves a pediatric patient younger than 5 years who requires reliable central venous access for prolonged medication administration, parenteral nutrition, or frequent blood sampling. For example, a 9-month-old infant with short bowel syndrome and failure to thrive admitted for initiation of long-term total parenteral nutrition (TPN) undergoes placement of a tunneled or non-tunneled central venous catheter via the internal jugular or femoral vein under general anesthesia in the operating room or in an interventional radiology suite. The clinical workflow includes pre-procedure consent and time-out, appropriate sedation/anesthesia, ultrasound-guided venous access, catheter insertion and securement, confirmation of catheter tip position by fluoroscopy or chest radiograph, application of sterile dressings, documentation of catheter type and length, and post-procedure monitoring for complications such as pneumothorax, bleeding, or infection. Discharge planning addresses catheter care, home infusion teaching, and scheduling of follow-up for catheter management and dressing changes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician or nonfacility professional portion of a service (rare for 36555 when facility billing separates components). |