Summary & Overview
CPT 36825: Arteriovenous Fistula with Autogenous Vein Graft
CPT code 36825 represents the surgical creation of an arteriovenous fistula using an autogenous vein graft to provide vascular access for hemodialysis. As a foundational procedure for patients with end-stage kidney disease, this code captures a key step in chronic dialysis care and factors into facility and provider planning for vascular surgery services. Nationally, access creation rates, practice patterns, and reimbursement for AVF procedures influence capacity for dialysis access and downstream care coordination.
Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the service type. The publication also summarizes what to expect in benchmarking and policy-oriented sections: utilization benchmarks, coding and billing considerations, and relevant updates affecting surgical vascular access reimbursement. Where specific payer policies or local coverage determinations apply, those details are signposted for readers to consult payer resources directly.
This executive summary equips clinicians, billing staff, and policy analysts with an understanding of what CPT code 36825 documents, why it matters in the national dialysis care pathway, and which payers are commonly involved in coverage and payment for this service.
Billing Code Overview
CPT code 36825 describes the surgical creation of an arteriovenous fistula (AVF) using an autogenous vein graft from the patient to connect an artery and a vein. This procedure is performed to establish durable vascular access for hemodialysis.
Service type: Surgical vascular access creation
Typical site of service: Operating room or vascular surgery suite
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with end-stage renal disease secondary to diabetic nephropathy is scheduled for creation of a permanent vascular access for hemodialysis. Preoperative evaluation includes review of vascular mapping (duplex ultrasound) demonstrating a suitable cephalic vein and radial artery in the non-dominant forearm. The patient presents to an outpatient ambulatory surgical center or hospital operating room on the day of surgery. Under regional block or general anesthesia, the vascular surgeon exposes the selected artery and autogenous vein, performs mobilization and vessel preparation, and creates an end-to-side arteriovenous fistula using the patients vein. Hemostasis is achieved, the incision is closed, and postoperative instructions are provided for fistula maturation and dialysis planning. Typical perioperative workflow includes pre-op consent and vascular mapping, anesthesia evaluation, intraoperative monitoring and documentation of artery and vein used, and postoperative orders for anticoagulation, wound care, and outpatient fistula maturation assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier specified (placeholder) | Generally not reported; neutral code in the input list. |
11 |