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    OpenPayerBilling CodesHemodialysis Access, Intervascular Cannulation for Extracorporeal Circulation, or Shunt Insertion Procedures on Arteries and VeinsCPT cpt-36821-arteriovenous-anastomosis-for-hemodialysis-access
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    CPT 36821: Arteriovenous Anastomosis Creation for Hemodialysis Access

    Medicare pays $603 on average nationally for this procedure.

    CPT code 36821 describes surgical creation of an arteriovenous (AV) anastomosis by connecting a vein to an artery to provide durable vascular access for hemodialysis; the service is a surgical vascular access procedure typically performed in an operating room or vascular surgery suite or similar procedural setting to establish access for patients with kidney failure who will receive hemodialysis treatments.

    For related coverage guidance, see recent payer policy updates: Vafseo (vadadustat) for anemia in CKD on dialysis, Metabolic Disorders - Cysteamine (Oral) Products for Individual and Family Plans, Kerendia (finerenone) — Coverage Criteria.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old patient with end-stage renal disease (ESRD) due to diabetic nephropathy is scheduled for creation of an arteriovenous (AV) fistula to provide durable vascular access for maintenance hemodialysis. The patient is evaluated in vascular surgery clinic with a history of progressive renal failure, rising serum creatinine, and anticipated need for regular hemodialysis sessions. Preoperative workflow includes vascular mapping with duplex ultrasound to locate a suitable artery and vein (commonly radial artery and cephalic vein at the wrist or brachial artery and cephalic/basilic vein at the elbow), medical optimization including review of anticoagulation and comorbidities (e.g., diabetes, hypertension), informed consent discussing risks and benefits, and scheduling for an operating room or procedure suite. On the day of service, the patient undergoes regional or general anesthesia; the surgeon creates the arteriovenous anastomosis by directly connecting the chosen vein to the artery (36821). Postoperative workflow includes monitoring for immediate complications (bleeding, thrombosis, distal ischemia), instructions on limb protection, and plans for serial maturation assessment (physical exam and duplex ultrasound) before initial cannulation for hemodialysis, typically several weeks after successful fistula maturation.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    36901Thrombolysis, infusion technique, for dialysis access graft or fistula, including catheter placement, radiologic supervision and interpretationPerformed if the AV fistula thromboses and requires endovascular thrombolysis post-creation or during follow-up.
    36902Thrombolysis mechanically assisted, for dialysis access graft or fistula, including radiologic supervision and interpretationAlternative endovascular treatment for access thrombosis or salvage after 36821 if problems arise.
    36825Creation of arteriovenous fistula; each subsequent vein, upper or lower extremity (List separately in addition to code for primary procedure)Billed when additional fistula creation in same operative session or additional vein used beyond primary anastomosis.
    36832Revision of arteriovenous fistula, with thrombectomy, with or without repair, other than dialysis access graftsUsed when a previously created fistula (from 36821) requires surgical revision due to stenosis or thrombosis.
    36907Transcatheter placement of intravascular stent(s), dialysis circuit, including radiologic supervision and interpretation when performedMay be used in adjunct endovascular procedures to maintain patency of the outflow vein following creation or during subsequent interventions.

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207K00000X
    207L00000X
    2080P0207X
    363A00000X
    209800000X
    261QS0132X
    163WX0106X
    282E00000X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    D63.1Anemia in chronic kidney disease
    E10.22Type 1 diabetes mellitus with diabetic chronic kidney disease
    E11.22Type 2 diabetes mellitus with diabetic chronic kidney disease
    E78.5Hyperlipidemia, unspecified
    I10Essential (primary) hypertension
    I12.0Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
    I13.10Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
    I13.11Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
    I50.9Heart failure, unspecified
    I82.403Acute embolism and thrombosis of unspecified deep veins of lower extremity, bilateral

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Nephrology1 / 3

    10 rows

    PolicyPayerEffective Date
    Vafseo (vadadustat) for anemia in CKD on dialysisCigna2026-08-15
    Metabolic Disorders - Cysteamine (Oral) Products for Individual and Family PlansCigna2026-08-15
    Kerendia (finerenone) — Coverage CriteriaBlue Cross Blue Shield - Iowa2026-08-05
    Voyxact (sibeprenlimab-szsl) — Prior authorization / medical necessity for primary IgA nephropathyColorado Rocky Mountain Health Plans2026-08-01
    Oxlumo (lumasiran) and Rivfloza (nedosiran) — Coverage Criteria (Ohio)Colorado Rocky Mountain Health Plans2026-08-01
    Korsuva (difelikefalin) — Medical Benefit Drug Coverage Criteria (Ohio)Colorado Rocky Mountain Health Plans2026-08-01
    Complement Inhibitors - EmpaveliCigna2026-08-01
    Tolvaptan (Jynarque)Cigna2026-08-01
    Nephrology - Filspari (sparsentan) coverageCigna2026-08-01
    Rivfloza (nedosiran) prior authorization for PH1UnitedHealthcare2026-08-01

    Related Codes

    CPT-36800-HEMODIALYSIS-CANNULA-INSERTION-TWO-VEINS

    CPT 36800: Insertion of Cannulae for Hemodialysis, Two Veins

    CPT-36810-HEMODIALYSIS-SCRIBNER-TYPE-CANNULATION

    CPT 36810: Scribner-Type Arteriovenous Cannulation for Hemodialysis

    CPT-36815-HEMODIALYSIS-CANNULA-REPOSITIONING-OR-REMOVAL

    CPT 36815: Reposition or Removal of Hemodialysis Cannula

    CPT-36818-CEPHALIC-TO-BRACHIAL-ARTERIOVENOUS-ANASTOMOSIS-UPPER-ARM

    CPT 36818: Cephalic Vein to Brachial Artery Arteriovenous Anastomosis

    CPT-36819-BASILIC-TO-BRACHIAL-AV-FISTULA-CREATION-UPPER-ARM

    CPT 36819: Basilic Vein to Brachial Artery Arteriovenous Anastomosis

    CPT-36820-ARTERIOVENOUS-ANASTOMOSIS-FOREARM-FISTULA-CREATION

    CPT 36820: Arteriovenous Anastomosis, Forearm for Hemodialysis

    CPT-36823-ISOLATED-EXTRACORPOREAL-REGIONAL-CHEMOTHERAPY-PERFUSION-EXTREMITY

    CPT 36823: Isolated Limb Perfusion with Extracorporeal Circulation

    CPT-36825-ARTERIOVENOUS-FISTULA-AUTOGENOUS-VEIN-GRAFT

    CPT 36825: Creation of Arteriovenous Fistula with Autogenous Vein Graft

    CPT-36830-ARTERIOVENOUS-FISTULA-NONAUTOGENOUS-GRAFT-HEMODIALYSIS-ACCESS

    CPT 36830: Arteriovenous Fistula with Nonautogenous Graft

    CPT-36831-ARTERIOVENOUS-FISTULA-THROMBECTOMY

    CPT 36831: Open Thrombectomy of Arteriovenous Fistula

    Showing 1–10 of 18

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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