CPT 36589 Removal of Central Venous Device Reimbursement

CPT code 36589 represents the surgical removal of a central venous access device, a procedure essential for patients who no longer require long-term intravenous access or who experience device-related complications. This code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage for patients undergoing this procedure.

The publication provides a comprehensive overview of 36589, detailing its clinical significance, typical site of service, and the payer landscape. Readers will gain insights into current billing benchmarks, policy updates, and the clinical context surrounding central venous access device removal. The analysis also highlights common modifiers used in conjunction with this code and outlines relevant physician taxonomies and associated ICD-10 diagnoses, offering a clear understanding of how this procedure is documented and reimbursed.

Healthcare professionals, administrators, and policy analysts will find valuable information on payer coverage, coding practices, and regulatory considerations. The report is designed to support informed decision-making and enhance understanding of the procedural, clinical, and billing aspects of central venous access device removal at a national level.

CPT Code Overview

CPT code 36589 is used to report the removal of a central venous access device. This procedure is classified under surgery and is typically performed in an outpatient hospital setting (Place of Service 22). Central venous access devices are commonly used for long-term intravenous therapies, and their removal is a significant clinical event, often required due to complications, completion of therapy, or device malfunction. The procedure involves surgical techniques to safely extract the device while minimizing risks to the patient.

Clinical Context

A patient with a central venous access device, such as a port or catheter, may require removal due to complications like infection, mechanical malfunction, or completion of therapy. The procedure is typically performed in an outpatient hospital setting by a surgical specialist. The clinical workflow involves pre-procedure assessment, sterile removal of the device, and post-procedure monitoring for complications such as bleeding or infection. Patients may present with symptoms related to device malfunction or infection, or may be referred for device removal after completion of treatment.

Coding Specifications

Modifier 59: Distinct Procedural Service. Used when the removal procedure is performed separately from other procedures, indicating it is not part of a bundled service.
Modifier 51: Multiple Procedures. Applied when more than one surgical procedure is performed during the same session.

Modifier Code	Description
`59`	Distinct Procedural Service

Medicare's national mean rate for CPT code 36589 is $170.58, which is notably lower than the BUCA (average commercial) mean rate of $217.69. Among the commercial payers, UnitedHealth Group has the highest mean rate at $285.24, while Aetna is the lowest at $179.67.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range at $15.00, indicating relatively consistent reimbursement rates. In contrast, UnitedHealth Group exhibits the widest range at $165.00, reflecting greater variability in commercial payments. Cigna also has a wide dispersion at $134.50, while Aetna and Blue Cross Blue Shield are more moderate.

The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.

Taxonomy Code	Specialty
`208600000X`	Surgery Physician
`208800000X`	Urology Physician
`207XS0117X`	Surgical Oncology Physician

Related Diagnoses

T82.590A: Other mechanical complication of other vascular devices, implants and grafts, initial encounter
- Indicates a patient is experiencing a mechanical issue with a vascular device, which may necessitate removal.
T82.7XXA: Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter
- Used when infection or inflammation is present, prompting device removal.
Z45.2: Encounter for adjustment and management of vascular access device
- Reflects a clinical visit for managing or removing a vascular access device.
Z46.82: Encounter for fitting and adjustment of vascular access device
- Used for visits related to adjustment or removal of the device.
Z95.828: Presence of other vascular implants and grafts
- Indicates the patient has a vascular implant, relevant for documentation during removal procedures.

Related CPT Codes

36590: Removal of Central Venous Access Device

CPT Code	Description
`36590`	Removal of Central Venous Access Device

36590 is related to 36589 and may be used as an alternative or in conjunction, depending on the specific type of device or clinical scenario. Both codes pertain to the removal of central venous access devices, and selection depends on the device characteristics and procedural details.

The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.

OpenPayer

Summary & Overview

CPT 36589: Removal of Central Venous Access Device