CPT 36585 PICC Replacement Reimbursement | OpenPayer

Summary & Overview

CPT 36585: Complete Replacement of PICC for Infection or Malfunction

CPT code 36585 covers the complete replacement of a peripherally inserted central venous catheter (PICC) when the existing line is infected, complicated by phlebitis, or otherwise malfunctioning. This service is clinically significant because timely, appropriate replacement of an infected or malfunctioning central line reduces bloodstream infection risk, restores vascular access for essential therapies, and can prevent escalation of care. Nationally, the code is relevant across acute and ambulatory care settings where central venous access is managed.

Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical scenario and service context for 36585, plus what to expect in coverage and billing practice. The publication summarizes typical sites of service, common clinical indications, and operational considerations tied to central line replacement. It also outlines benchmarks and policy-relevant elements commonly reviewed by payers and clinicians such as appropriateness of replacement for infection versus routine exchange, and documentation elements that support medical necessity.

This national overview is intended to help billing, clinical, and administrative stakeholders understand where CPT code 36585 fits into practice workflows, payer coverage conversations, and coding registries. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 36585central venous catheterPICC replacementvascular accessinfection managementhospital outpatientprocedure codingbilling compliance

Billing Code Overview

CPT code 36585 describes a complete replacement of a peripherally inserted central venous catheter (PICC) performed when the existing line is infected, has phlebitis, or is malfunctioning. This procedure involves removal of the indwelling PICC and placement of a new central venous catheter to restore reliable central venous access.

Service type: Invasive vascular device replacement
Typical site of service: Hospital inpatient or outpatient procedure area, emergency department, or ambulatory surgical center depending on clinical urgency and patient status

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old hospitalized patient with a history of long-term intravenous antibiotics for osteomyelitis develops fever, erythema, and purulence at the peripherally inserted central catheter (PICC) exit site. Blood cultures return positive and the PICC is suspected to be the source of catheter-related bloodstream infection. Interventional radiology or an inpatient vascular access team performs a complete replacement of the PICC under sterile conditions because of infection and malfunction. The clinical workflow includes pre-procedure consent and review, removal of the infected PICC, site assessment and decontamination, placement of a new PICC using ultrasound guidance and fluoroscopic confirmation of catheter tip position, documentation of indication (infection/malfunction), culture results, and post-procedure monitoring for complications such as bleeding or pneumothorax. This service is typically performed in an inpatient general hospital or outpatient ambulatory surgical center depending on patient stability and local practice patterns.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or resources exceed usual for PICC replacement (e.g., extensive infection debridement or complex anatomy).
`23`

CPT 36583: Complete Replacement of Tunneled Central Venous Catheter

CPT-36582-TUNNELED-CVA-CATHETER-REPLACEMENT

CPT 36582: Complete Replacement of Tunneled Central Venous Catheter

CPT-36581-REPLACEMENT-TUNNELED-CENTRAL-VENOUS-CATHETER

CPT 36581: Replacement of Tunneled Central Venous Catheter

CPT-36584-PICC-COMPLETE-REPLACEMENT-INFECTION-MALFUNCTION

CPT 36584: Complete Replacement of PICC for Infection or Malfunction

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

CPT 36580: Replacement of Non-Tunneled Central Venous Catheter

Taxonomy Code	Specialty	Notes
363A00000X	Vascular Surgery	Vascular surgeons frequently manage central venous access in complex cases.
363L00000X	Interventional Radiology	Interventional radiologists commonly perform PICC placement/replacement under imaging guidance.
207RH0000X	Hospitalist/Internal Medicine	Hospitalists often coordinate inpatient vascular access and may perform bedside PICC management.
208D00000X	General Surgery	General surgeons may be involved in catheter removal and complex replacements in surgical patients.
207P00000X	Emergency Medicine	Emergency physicians may perform urgent PICC replacement in ED settings when indicated.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T82.7XXA`	Infection and inflammatory reaction due to other vascular prosthetic devices, implants and grafts, initial encounter	Applicable when the PICC is the source of device-related infection requiring removal and replacement.
`T82.6XXA`	Mechanical complication of other vascular device, implant and graft, initial encounter	Used when catheter malfunction (occlusion, fracture) necessitates complete replacement.
`A41.9`	Sepsis, unspecified organism	Used when bloodstream infection from the catheter leads to systemic sepsis requiring catheter exchange.
`L02.91`	Cutaneous abscess, unspecified site	Relevant when there is localized purulence at the PICC exit site or tunnel infection.
`I82.90`	Acute embolism and thrombosis of unspecified vein	Used when catheter-associated thrombosis complicates catheter function and prompts replacement.
`Z45.2`	Encounter for adjustment and management of vascular access device	Used for encounters related to management and replacement of vascular access devices like PICC.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36589`	Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump	Alternative central venous access method when PICC is not suitable or failed; may be performed if PICC replacement unsuccessful.
`36556`	Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older	Performed when immediate central access is required and PICC replacement is not appropriate.
`36568`	Placement of an implantable venous access port or catheter, including subcutaneous pocket creation	Considered when long-term intermittent access is needed instead of repeat PICC placements.
`36575`	Subcutaneous port replacement, revision or removal	May be performed in the same patient if an implanted port is present or being exchanged for long-term therapy.
`36010`	Arterial catheterization or insertion of catheter into artery	Often performed for concurrent arterial access in critically ill patients receiving central line management; related vascular access procedure.

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