Summary & Overview
CPT 36836: Percutaneous Upper-Limb Arteriovenous Fistula Creation
CPT code 36836 represents a percutaneous procedure to create an arteriovenous fistula between a peripheral artery and peripheral vein in the upper limb to establish hemodialysis access. This procedure is a key option in vascular access management for patients requiring chronic dialysis because it can provide durable access with potentially lower infection and complication rates compared with central venous catheters.
Major national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find an overview of clinical context for arteriovenous fistula creation, expected sites of service, and commonly observed billing and coverage considerations. The publication summarizes typical payment and policy themes across payers, highlights where national coverage practices align or diverge, and notes common modifiers and reporting practices when available. Where payer-specific benchmarks and policy updates are available, those are summarized to help coding, billing, and administrative teams understand reimbursement pathways and documentation expectations for this procedure nationally.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related service-line specifics is noted where applicable elsewhere in the full publication.
Billing Code Overview
CPT code 36836 describes a percutaneous creation of an arteriovenous fistula between a peripheral artery and peripheral vein in the upper limb for hemodialysis access. The procedure establishes a direct connection (fistula) through a single access site for the involved peripheral artery and peripheral vein.
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Service type: Percutaneous vascular access/fistula creation
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Typical site of service: Hospital outpatient department or ambulatory surgical center; performed on the upper limb for hemodialysis access
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with end-stage renal disease secondary to long-standing diabetes and hypertension is scheduled for a percutaneous arteriovenous fistula creation in the upper extremity to establish durable hemodialysis access. The vascular surgeon reviews vascular duplex imaging demonstrating a suitable peripheral artery and vein in the non-dominant arm. The patient presents to an outpatient vascular interventional suite on the day of service, receives procedural sedation and local anesthesia, and the team uses ultrasound and fluoroscopic guidance to create a single percutaneous connection between the peripheral artery and vein via one access site. The immediate workflow includes pre-procedure consent and time-out, ultrasound mapping, percutaneous access, fistula creation and confirmation of flow, hemostasis and dressing application, post-procedure monitoring for complications (bleeding, thrombosis, ischemia), and discharge with follow-up scheduling for maturation assessment and dialysis cannulation planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier specified by payer | Rarely used; include only if required by payer billing rules for unspecified modifier field |
22 | Increased procedural services |