CPT 36584 PICC Replacement Reimbursement | OpenPayer

Summary & Overview

CPT 36584: Complete Replacement of PICC for Infection or Malfunction

CPT code 36584 represents the complete replacement of a peripherally inserted central venous catheter (PICC) performed for infection, phlebitis, or malfunction and includes imaging guidance and radiologic supervision and interpretation. This procedural code is important nationally because PICC replacement is a common vascular access intervention across inpatient and outpatient settings, influencing hospital utilization, interventional radiology workload, and billing practices for device-related complications. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service and typical sites of care, an overview of payer coverage and coding practice considerations, and benchmarks for utilization and reimbursement where available. The publication also outlines the clinical context for when complete PICC replacement is coded versus other device-management codes, and highlights common documentation elements tied to radiologic supervision and interpretation that affect coding clarity. Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, or related codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare36584CPTPICC replacementinterventional radiologyvascular accessradiologic supervisiondevice replacementoutpatient procedure

Billing Code Overview

CPT code 36584 describes a complete replacement of a peripherally inserted central venous catheter (PICC) performed when the existing catheter is infected, has phlebitis, or is malfunctioning. The service includes all imaging guidance, documentation, and radiologic supervision and interpretation (RS&I) as part of the replacement procedure. The description specifies that this procedure does not include subcutaneous port or pump placement.

Service type: Device replacement / interventional vascular procedure

Typical site of service: Interventional radiology suite, hospital inpatient or outpatient setting, or ambulatory surgical center

Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, or related codes.

Clinical & Coding Specifications

Clinical Context

A 62-year-old hospitalized patient with a history of metastatic colon cancer who has a peripherally inserted central catheter (PICC) placed for long-term chemotherapy presents with signs of catheter-related infection: fever, erythema and tenderness along the catheter tract, and positive blood cultures for Staphylococcus aureus. The interventional radiology team evaluates the patient, documents catheter dysfunction and infection, and determines that complete removal and replacement of the PICC over a new insertion site is required. The procedure is performed in an outpatient interventional radiology suite or inpatient radiology department under ultrasound and fluoroscopic guidance with radiologic supervision and interpretation.

Clinical workflow:

Pre-procedure: review indication, consent, recent labs, blood cultures, and imaging; intravenous antibiotics initiated as indicated.
Procedure: ultrasound-guided venous access, removal of the infected PICC, placement of a new PICC with fluoroscopic confirmation of tip position; documentation of RS&I provided by the radiologist.
Post-procedure: monitor for bleeding or immediate complications, document insertion site condition, send removed catheter for culture if indicated, update anticoagulation or antibiotic plans, and provide discharge or inpatient orders.

Coding Specifications

Modifier	Description	When to Use

CPT 36581: Replacement of Tunneled Central Venous Catheter

CPT-36585-PICC-COMPLETE-REPLACEMENT-FOR-INFECTION-OR-MALFUNCTION

CPT 36585: Complete Replacement of PICC for Infection or Malfunction

CPT-36582-TUNNELED-CVA-CATHETER-REPLACEMENT

CPT 36582: Complete Replacement of Tunneled Central Venous Catheter

CPT-36580-NON-TUNNELED-CVA-CATHETER-REPLACEMENT

CPT 36580: Replacement of Non-Tunneled Central Venous Catheter

CPT-36583-TUNNELED-CVA-CATHETER-COMPLETE-REPLACEMENT

CPT 36583: Complete Replacement of Tunneled Central Venous Catheter

Taxonomy Code	Specialty	Notes
207RP0000X	Interventional Radiology	Radiologists who perform image-guided PICC removal and placement.
208000000X	Diagnostic Radiology	Radiologists providing RS&I and image guidance.
363L00000X	Vascular Surgery	Vascular surgeons who may perform complex catheter procedures.
208M00000X	General Practice/Family Medicine	Hospitalists or generalists who may coordinate care and place PICCs in some settings.
364S00000X	Nursing (Vascular Access Specialist)	Vascular access nurses who perform PICC insertions in many institutions (taxonomy reflects nursing specialty).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T82.7XXA`	Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter	Applies to infection related to an indwelling vascular catheter requiring removal and replacement.
`T82.81XA`	Acute embolism and thrombosis of cardiac device, implant and graft, initial encounter	Relevant when catheter thrombosis or embolic complications lead to malfunction and replacement.
`I80.9`	Phlebitis and thrombophlebitis of unspecified site	Phlebitis along the catheter tract can necessitate PICC removal and replacement.
`A41.9`	Sepsis, unspecified organism	Systemic infection from catheter-related bloodstream infection requiring catheter management.
`R50.9`	Fever, unspecified	Common presenting symptom prompting evaluation of catheter infection or malfunction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36584`	Replacement, complete, of peripherally inserted central venous catheter (PICC) including all imaging guidance, documentation, and RS&I	Principal procedure for complete removal and replacement of an infected or malfunctioning PICC.
`36561`	Insertion of tunneled centrally inserted central venous catheter, with subcutaneous port or pump, with imaging guidance	Alternative central venous access option when conversion from PICC to tunneled catheter or port is clinically indicated.
`36556`	Insertion of non-tunneled centrally inserted central venous catheter, without subcutaneous port or pump, with imaging guidance	Used when placement of a temporary central line is required instead of PICC.
`36147`	Insertion of non-tunneled centrally inserted central venous catheter via peripheral vein, with imaging guidance	Related access technique codes for central venous catheter placement using peripheral access.
`76000`	Fluoroscopy (separate procedure), up to 1 hour physician supervision	Represents imaging resources that may be reported when the technical and professional components are billed separately from catheter procedure.

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