Summary & Overview
CPT 36819: Basilic-to-Brachial AV Fistula Creation for Hemodialysis
CPT code 36819 covers the surgical creation of an arteriovenous anastomosis connecting the basilic vein to the brachial artery in the upper arm to establish reliable vascular access for hemodialysis. This procedure is a common and clinically significant intervention for patients with end-stage kidney disease who require long-term hemodialysis, affecting national patterns of surgical vascular access and dialysis readiness.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for AV fistula creation, typical sites of service, and the primary factors that influence coding and billing for this procedure. The publication also summarizes common modifiers and payer considerations relevant to claims processing and reimbursement, highlights benchmarks and utilization trends where available, and outlines recent policy or coverage dynamics that affect access to fistula creation nationally.
The content is intended for clinical administrators, coding professionals, and policy analysts seeking a clear, national-level understanding of CPT code 36819, including its role in dialysis preparation, operational implications for surgical and ambulatory settings, and the payer landscape that influences claim adjudication and access to care.
Billing Code Overview
CPT code 36819 describes the surgical creation of an arteriovenous anastomosis by connecting the basilic vein to the brachial artery in the upper arm to provide durable vascular access for patients with kidney failure who will receive hemodialysis.
Service type: Surgical creation of arteriovenous (AV) fistula for hemodialysis access.
Typical site of service: Hospital operating room or ambulatory surgery center (upper arm/vascular access procedural suite).
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with end-stage renal disease (ESRD) requiring long-term hemodialysis is scheduled for creation of a left upper-arm arteriovenous fistula via transposition/creation of a basilic vein to brachial artery anastomosis. The patient has a history of diabetes mellitus and hypertension, with prior failed radiocephalic and brachiocephalic accesses. Preoperative duplex ultrasound mapping confirms a suitable basilic vein and brachial artery. The procedure is performed in an outpatient hospital or ambulatory surgical center under regional block or monitored anesthesia care. The vascular surgeon makes an upper-arm incision, mobilizes and transposes the basilic vein as needed, creates an end-to-side anastomosis to the brachial artery, ensures hemostasis, and closes the wound. Postoperatively, the patient is observed for access thrill, distal perfusion, and wound complications, receives instructions for access care, and is scheduled for follow-up and potential maturation assessment and interventions (e.g., ultrasound surveillance, percutaneous interventions) prior to dialysis cannulation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician professional component separate from facility/technical services, rarely used for surgical procedure global billing. |
50 |