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CPT 36680: Intraosseous Infusion via Bone Marrow Needle Insertion

CPT code 36680 denotes intraosseous infusion via direct bone marrow needle insertion, a critical emergency procedure used when peripheral intravenous access cannot be obtained. Nationally, this code captures a time‑sensitive, life‑saving technique employed in emergency departments, ambulances, and other acute care settings for rapid administration of fluids, blood products, and medications.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of coding intent and clinical context, payer coverage patterns, and common billing practices. Readers will find benchmarks for utilization and reimbursement trends where available, summaries of relevant policy updates or coverage statements from major payers, and guidance on documentation elements that support accurate coding.

This resource is written for clinicians, billing professionals, and policy analysts seeking a national perspective on how CPT code 36680 is used and adjudicated across major payers. Data not available in the input will be noted as such in detailed sections.

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Billing Code Overview

CPT code 36680 describes the insertion of a needle directly into the bone marrow to permit intraosseous infusion of fluids or medications when intravenous access is difficult or not feasible. This procedure provides a rapid, reliable route for vascular access in emergency and peri‑resuscitation settings.

Service type: Emergency vascular access procedure
Typical site of service: Emergency department, prehospital/field care, or other acute care settings where rapid vascular access is required

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CPT 36680: Intraosseous Infusion via Bone Marrow Needle Insertion

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Billing Code Overview

Service type: Emergency vascular access procedure
Typical site of service: Emergency department, prehospital/field care, or other acute care settings where rapid vascular access is required

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult or pediatric emergency patient in whom peripheral intravenous access is difficult or impossible during resuscitation, severe dehydration, shock, cardiac arrest, or major trauma. The clinical workflow begins with airway, breathing, circulation assessment; attempts at peripheral IV access are made and documented. When IV access cannot be rapidly achieved, the provider performs an intraosseous (IO) needle insertion — commonly into the proximal tibia, distal femur (pediatrics), or proximal humerus — to secure vascular access for fluid resuscitation, blood products, vasoactive drugs, or emergency medications. The procedure is performed at the bedside in the emergency department, prehospital setting (ambulance), intensive care unit, or operating room under aseptic technique; confirmation of placement by aspiration of marrow or saline flush and securement of the device follows. Documentation includes indication, site, device type, number of attempts, patient tolerance, medications/fluid administered through the IO, and any complications (e.g., extravasation, compartment syndrome, infection).

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional component of a service associated with another billed facility or technical component.
`50`	Bilateral procedure	Use when IO access is performed bilaterally during the same encounter (rare; document medical necessity).
`51`	Multiple procedures	Use when multiple distinct procedures are billed during the same session in addition to the IO insertion.
`52`	Reduced services	Use when the IO procedure is partially reduced or not completed as documented.
`53`	Discontinued procedure	Use when the IO insertion is started but discontinued due to patient condition or safety concerns.
`59`	Distinct procedural service	Use when the IO insertion is distinct and separate from another procedure performed at the same encounter.
`76`	Repeat procedure by same physician	Use when the same provider repeats IO insertion during the same encounter (e.g., initial attempt failed and repeat performed).
`77`	Repeat procedure by another physician	Use when a different provider repeats the IO insertion during the same encounter.
`78`	Return to operating/procedure room for a related procedure during postoperative period	Use when a related procedure to the IO access occurs during the global period and requires return to procedure area.
`79`	Unrelated procedure or service by same physician during postoperative period	Use when an unrelated, separate procedure (including IO insertion) is performed during the postoperative global period.
`AS`	Ambulatory surgical center payment modifier	Use when the service is furnished in an Ambulatory Surgical Center setting and the modifier is required by payer.
`LT`	Left side	Use to designate IO insertion on the left extremity when laterality is required by payer.
`RT`	Right side	Use to designate IO insertion on the right extremity when laterality is required by payer.
`59`	Distinct procedural service	(Listed above) Use also when documentation supports that the IO access is distinct from other services billed.

Taxonomy Code	Specialty	Notes
208000000X	Emergency Medicine	Most common specialty performing emergent IO access in ED and prehospital care.
207P00000X	Critical Care Medicine	Performs IO access in ICU or during resuscitation.
207K00000X	Anesthesiology	May perform IO access during perioperative emergencies.
208000000X-Pediatrics*	Pediatric Emergency Medicine	Pediatric subspecialty focusing on pediatric IO access (proximal tibia, distal femur, proximal humerus).
363LP0800X	Paramedic/Prehospital Provider	Prehospital providers frequently place IO access in the field.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R57.0`	Cardiogenic shock	IO access may be used during resuscitation when IV access is unobtainable.
`R57.9`	Shock, unspecified	Rapid vascular access via IO is indicated for fluid and medication delivery in shock.
`I46.9`	Cardiac arrest, cause unspecified	IO access commonly used during cardiac arrest to deliver emergency drugs.
`T79.A11`	Traumatic compartment syndrome of left lower limb	IO access may be needed in trauma patients when IV access is difficult (note: monitor for extravasation complications).
`E86.0`	Dehydration	Severe dehydration with collapsed veins may necessitate IO access for rehydration.
`S72.001A`	Fracture of unspecified part of neck of femur, initial encounter	In traumatic skeletal injuries when peripheral IV access is not available, IO access can be used.
`D50.9`	Iron deficiency anemia, unspecified	Patients requiring urgent blood product administration when IV access cannot be obtained may receive IO access.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36680`	Intraosseous needle/insertion for infusion, any age	Primary procedure code for establishing intraosseous access for infusion when IV access is difficult.
`96360`	Intravenous infusion, hydration; initial, 31 minutes to 1 hour	May be billed for administered fluids through established IO access when documentation supports infusion duration.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Use for individual medication injections administered via IO if payer permits coding of the drug administration separately.
`36415`	Collection of venous blood by venipuncture	May be performed before or after IO access for laboratory testing; not a replacement for IO blood sampling coding.
`77002`	Fluoroscopic guidance for needle placement (if applicable)	Rarely used; only if imaging guidance beyond standard technique is documented and billed.

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional component of a service associated with another billed facility or technical component.
`50`	Bilateral procedure	Use when IO access is performed bilaterally during the same encounter (rare; document medical necessity).
`51`	Multiple procedures	Use when multiple distinct procedures are billed during the same session in addition to the IO insertion.
`52`	Reduced services	Use when the IO procedure is partially reduced or not completed as documented.
`53`	Discontinued procedure	Use when the IO insertion is started but discontinued due to patient condition or safety concerns.
`59`	Distinct procedural service	Use when the IO insertion is distinct and separate from another procedure performed at the same encounter.
`76`	Repeat procedure by same physician	Use when the same provider repeats IO insertion during the same encounter (e.g., initial attempt failed and repeat performed).
`77`	Repeat procedure by another physician	Use when a different provider repeats the IO insertion during the same encounter.
`78`	Return to operating/procedure room for a related procedure during postoperative period	Use when a related procedure to the IO access occurs during the global period and requires return to procedure area.
`79`	Unrelated procedure or service by same physician during postoperative period	Use when an unrelated, separate procedure (including IO insertion) is performed during the postoperative global period.
`AS`	Ambulatory surgical center payment modifier	Use when the service is furnished in an Ambulatory Surgical Center setting and the modifier is required by payer.
`LT`	Left side	Use to designate IO insertion on the left extremity when laterality is required by payer.
`RT`	Right side	Use to designate IO insertion on the right extremity when laterality is required by payer.
`59`	Distinct procedural service	(Listed above) Use also when documentation supports that the IO access is distinct from other services billed.

Taxonomy Code	Specialty	Notes
208000000X	Emergency Medicine	Most common specialty performing emergent IO access in ED and prehospital care.
207P00000X	Critical Care Medicine	Performs IO access in ICU or during resuscitation.
207K00000X	Anesthesiology	May perform IO access during perioperative emergencies.
208000000X-Pediatrics*	Pediatric Emergency Medicine	Pediatric subspecialty focusing on pediatric IO access (proximal tibia, distal femur, proximal humerus).
363LP0800X	Paramedic/Prehospital Provider	Prehospital providers frequently place IO access in the field.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R57.0`	Cardiogenic shock	IO access may be used during resuscitation when IV access is unobtainable.
`R57.9`	Shock, unspecified	Rapid vascular access via IO is indicated for fluid and medication delivery in shock.
`I46.9`	Cardiac arrest, cause unspecified	IO access commonly used during cardiac arrest to deliver emergency drugs.
`T79.A11`	Traumatic compartment syndrome of left lower limb	IO access may be needed in trauma patients when IV access is difficult (note: monitor for extravasation complications).
`E86.0`	Dehydration	Severe dehydration with collapsed veins may necessitate IO access for rehydration.
`S72.001A`	Fracture of unspecified part of neck of femur, initial encounter	In traumatic skeletal injuries when peripheral IV access is not available, IO access can be used.
`D50.9`	Iron deficiency anemia, unspecified	Patients requiring urgent blood product administration when IV access cannot be obtained may receive IO access.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36680`	Intraosseous needle/insertion for infusion, any age	Primary procedure code for establishing intraosseous access for infusion when IV access is difficult.
`96360`	Intravenous infusion, hydration; initial, 31 minutes to 1 hour	May be billed for administered fluids through established IO access when documentation supports infusion duration.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Use for individual medication injections administered via IO if payer permits coding of the drug administration separately.
`36415`	Collection of venous blood by venipuncture	May be performed before or after IO access for laboratory testing; not a replacement for IO blood sampling coding.
`77002`	Fluoroscopic guidance for needle placement (if applicable)	Rarely used; only if imaging guidance beyond standard technique is documented and billed.

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 36680: Intraosseous Infusion via Bone Marrow Needle Insertion

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Billing Code Overview

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CPT 36680: Intraosseous Infusion via Bone Marrow Needle Insertion

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

References