CPT code 36835 represents the surgical creation of an arteriovenous shunt—most often an arteriovenous fistula or graft—placed to provide durable vascular access for hemodialysis. This procedure is a critical component of care for patients with advanced kidney failure who require long-term dialysis and has implications for surgical, nephrology, and dialysis delivery systems nationwide. Access type and surgical technique affect subsequent dialysis adequacy, complication risk, and downstream costs.

Key payers considered include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when and where the procedure is performed, payer coverage considerations, common billing modifiers, and related coding references. The publication outlines national benchmarks where available, highlights relevant policy and reimbursement updates affecting vascular access procedures, and provides operational guidance on common billing and documentation practices. Practical implications for hospital and ambulatory surgical settings—such as site-of-service selection and perioperative resource needs—are summarized to inform coding, billing, and clinical teams tasked with supporting dialysis access placement.