Find policies, billing codes, payers, states, and providers

CPT 36904: Dialysis Circuit Thrombectomy and Pharmacologic Thrombolysis

CPT code 36904 represents a fluoroscopically guided endovascular procedure to remove or dissolve blood clots from a dialysis circuit, including diagnostic angiography and radiological supervision and interpretation. This service is clinically important because thrombosis of dialysis access can cause dialysis interruption, catheter failure, and increased morbidity among patients dependent on hemodialysis. Timely endovascular intervention preserves access function and reduces the need for new access creation or hospital admission.

Key national payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage and billing considerations across these payers, typical sites of service and clinical context for use of the code, and comparative benchmarks where available. The publication summarizes procedural scope, common clinical scenarios prompting use of the code, and coding relationships relevant for billing teams and policy analysts. Data not available in the input is noted where payer-specific policy details, associated taxonomies, and ICD-10 diagnoses would normally be provided.

Customize your policy alerts

Sign up for cpt 36904 policy alerts

Get alerted when payer policies referencing 36904 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

CPT code 36904 describes a fluoroscopically guided thrombectomy and/or pharmacological thrombolytic injection of a clot within a dialysis circuit, performed through catheter introduction into a vascular access (the dialysis circuit). The procedure includes diagnostic angiography and radiological supervision and interpretation as part of the service.

Service type: Image-guided endovascular thrombectomy and pharmacologic thrombolysis of a dialysis circuit access
Typical site of service: Hospital interventional radiology suite or outpatient endovascular/vascular access procedural area where fluoroscopic imaging and angiographic equipment are available.

Find policies, billing codes, payers, states, and providers

CPT 36904: Dialysis Circuit Thrombectomy and Pharmacologic Thrombolysis

Customize your policy alerts

Sign up for cpt 36904 policy alerts

Get alerted when payer policies referencing 36904 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service type: Image-guided endovascular thrombectomy and pharmacologic thrombolysis of a dialysis circuit access
Typical site of service: Hospital interventional radiology suite or outpatient endovascular/vascular access procedural area where fluoroscopic imaging and angiographic equipment are available.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with end-stage renal disease presents to the interventional radiology suite with an acutely thrombosed arteriovenous fistula used for hemodialysis. The patient reports decreased thrill and inability to complete dialysis sessions. Under fluoroscopic guidance, the interventional radiologist or vascular surgeon performs diagnostic angiography of the dialysis circuit to localize the thrombus, introduces a catheter into the fistula or graft, and performs mechanical thrombectomy and/or pharmacologic thrombolytic infusion to restore patency. Radiological supervision and interpretation are provided throughout. The procedure is typically performed in an outpatient interventional radiology or hospital angiography suite with conscious sedation and local anesthesia; post-procedure monitoring assesses flow restoration and hemostasis before discharge or admission for observation if complications occur.

Coding Specifications

Modifier	Description	When to Use
`11`	Professional Component	When reporting only the physician’s professional work if the technical component is billed separately (rare for this code).
`22`	Increased Procedural Services	When work required is substantially greater than usual (documented increased complexity).
`52`	Reduced Services	When the service performed is partially reduced or not completed as planned.
`53`	Discontinued Procedure	When the procedure is started but discontinued due to patient condition or other unforeseen circumstance.
`59`	Distinct Procedural Service	When a separate, distinct procedure not normally reported together is performed in a different site or session (use with caution and documentation).
`62`	Two Surgeons	When two surgeons work together as primary surgeons performing distinct parts of the procedure.
`78`	Return to the OR for a Related Procedure During the Postoperative Period	If a related thrombectomy is required in the operating room during the global period.
`79`	Unrelated Procedure or Service by the Same Physician During the Postoperative Period	For an unrelated procedure during the global period.
`LT`	Left Side	To identify laterality when applicable to a left-sided vascular access site.
`RT`	Right Side	To identify laterality when applicable to a right-sided vascular access site.

Taxonomy Code	Specialty	Notes
207RG0200X	Interventional Radiology	Primary specialty performing fluoroscopic vascular thrombectomy and angiography.
2080P0222X	Vascular Surgery	Often performs dialysis access thrombectomy and associated access repair.
207K00000X	Diagnostic Radiology	May provide diagnostic angiography and interpretation in the vascular access setting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I97.1`	Complications of vascular prosthetic devices, implants and grafts	Applies when thrombosis involves a graft used for dialysis access.
`T82.89XA`	Other complications of cardiac and vascular prosthetic devices, implants and grafts, initial encounter	Used for complications of vascular access devices such as thrombosis requiring intervention.
`I82.4`	Acute embolism and thrombosis of unspecified deep veins of lower extremity	Represents acute thrombosis in venous structures that may affect access or require thrombectomy when access involves venous segments.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Relevant if arterial thrombotic events are encountered during angiography or access procedures.
`N18.6`	End stage renal disease	Primary underlying condition necessitating chronic dialysis and creation/use of vascular access subject to thrombosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`75894`	Injection procedure during endovascular imaging, radiological supervision and interpretation (hand-injection or power injector for contrast)	Used for the angiographic contrast injections that accompany diagnostic angiography of the dialysis circuit.
`36901`	Thrombolysis, open or percutaneous, dialysis circuit; including diagnostic angiography, radiological supervision and interpretation, initial thrombectomy/thrombolysis	Related dialysis access intervention codes for initial or simple access thrombectomy — may be used in conjunction or for different access types.
`36465`	Endovenous thermal ablation of incompetent vein, complete — single treatment area	May be performed in the same vascular suite when venous interventions for access are required, though different clinical indications.
`76937`	Ultrasound guidance for vascular access requiring image documentation, percutaneous; unilateral	Often used for ultrasound-guided needle or catheter placement into the dialysis circuit prior to fluoroscopic intervention.
`99152`	Moderate sedation services provided by the same physician performing the procedure, initial 15 minutes	Billed when the physician providing the thrombectomy also administers and monitors moderate (conscious) sedation during the procedure.

CPT 36901: Fluoroscopic Dialysis Circuit Contrast Angiography

CPT-36902-DIALYSIS-CIRCUIT-ANGIOGRAPHY-BALLOON-ANGIOPLASTY

CPT 36902: Dialysis Circuit Angiography with Balloon Angioplasty

CPT-36903-DIALYSIS-ACCESS-ANGIOGRAPHY-WITH-STENT-PLACEMENT

CPT 36903: Dialysis Access Angiography with Intravascular Stent Placement

CPT-36905-DIALYSIS-CIRCUIT-THROMBECTOMY-ANGIOPLASTY-ANGIOGRAPHY

CPT 36905: Dialysis Circuit Thrombectomy with Balloon Angioplasty and Angiography

CPT-36906-DIALYSIS-CIRCUIT-THROMBECTOMY-STENT-PLACEMENT

CPT 36906: Dialysis Circuit Thrombectomy with Angioplasty and Stent

CPT-36907-DIALYSIS-ACCESS-BALLOON-ANGIOPLASTY-CENTRAL-SEGMENT

CPT 36907: Dialysis Access Balloon Angioplasty, Central Segment

CPT-36908-DIALYSIS-CIRCUIT-INTRAVASCULAR-STENT-PLACEMENT

CPT 36908: Intravascular Stent Placement for Dialysis Circuit

CPT-36909-DIALYSIS-CIRCUIT-ENDOVASCULAR-OCCLUSION-EMBOLIZATION

CPT 36909: Permanent Endovascular Occlusion or Embolization of Dialysis Circuit

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`11`	Professional Component	When reporting only the physician’s professional work if the technical component is billed separately (rare for this code).
`22`	Increased Procedural Services	When work required is substantially greater than usual (documented increased complexity).
`52`	Reduced Services	When the service performed is partially reduced or not completed as planned.
`53`	Discontinued Procedure	When the procedure is started but discontinued due to patient condition or other unforeseen circumstance.
`59`	Distinct Procedural Service	When a separate, distinct procedure not normally reported together is performed in a different site or session (use with caution and documentation).
`62`	Two Surgeons	When two surgeons work together as primary surgeons performing distinct parts of the procedure.
`78`	Return to the OR for a Related Procedure During the Postoperative Period	If a related thrombectomy is required in the operating room during the global period.
`79`	Unrelated Procedure or Service by the Same Physician During the Postoperative Period	For an unrelated procedure during the global period.
`LT`	Left Side	To identify laterality when applicable to a left-sided vascular access site.
`RT`	Right Side	To identify laterality when applicable to a right-sided vascular access site.

Taxonomy Code	Specialty	Notes
207RG0200X	Interventional Radiology	Primary specialty performing fluoroscopic vascular thrombectomy and angiography.
2080P0222X	Vascular Surgery	Often performs dialysis access thrombectomy and associated access repair.
207K00000X	Diagnostic Radiology	May provide diagnostic angiography and interpretation in the vascular access setting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I97.1`	Complications of vascular prosthetic devices, implants and grafts	Applies when thrombosis involves a graft used for dialysis access.
`T82.89XA`	Other complications of cardiac and vascular prosthetic devices, implants and grafts, initial encounter	Used for complications of vascular access devices such as thrombosis requiring intervention.
`I82.4`	Acute embolism and thrombosis of unspecified deep veins of lower extremity	Represents acute thrombosis in venous structures that may affect access or require thrombectomy when access involves venous segments.
`I74.3`	Embolism and thrombosis of arteries of lower extremities	Relevant if arterial thrombotic events are encountered during angiography or access procedures.
`N18.6`	End stage renal disease	Primary underlying condition necessitating chronic dialysis and creation/use of vascular access subject to thrombosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`75894`	Injection procedure during endovascular imaging, radiological supervision and interpretation (hand-injection or power injector for contrast)	Used for the angiographic contrast injections that accompany diagnostic angiography of the dialysis circuit.
`36901`	Thrombolysis, open or percutaneous, dialysis circuit; including diagnostic angiography, radiological supervision and interpretation, initial thrombectomy/thrombolysis	Related dialysis access intervention codes for initial or simple access thrombectomy — may be used in conjunction or for different access types.
`36465`	Endovenous thermal ablation of incompetent vein, complete — single treatment area	May be performed in the same vascular suite when venous interventions for access are required, though different clinical indications.
`76937`	Ultrasound guidance for vascular access requiring image documentation, percutaneous; unilateral	Often used for ultrasound-guided needle or catheter placement into the dialysis circuit prior to fluoroscopic intervention.
`99152`	Moderate sedation services provided by the same physician performing the procedure, initial 15 minutes	Billed when the physician providing the thrombectomy also administers and monitors moderate (conscious) sedation during the procedure.

CPT 36901: Fluoroscopic Dialysis Circuit Contrast Angiography

CPT-36902-DIALYSIS-CIRCUIT-ANGIOGRAPHY-BALLOON-ANGIOPLASTY

CPT 36902: Dialysis Circuit Angiography with Balloon Angioplasty

CPT-36903-DIALYSIS-ACCESS-ANGIOGRAPHY-WITH-STENT-PLACEMENT

CPT 36903: Dialysis Access Angiography with Intravascular Stent Placement

CPT-36905-DIALYSIS-CIRCUIT-THROMBECTOMY-ANGIOPLASTY-ANGIOGRAPHY

CPT 36905: Dialysis Circuit Thrombectomy with Balloon Angioplasty and Angiography

CPT-36906-DIALYSIS-CIRCUIT-THROMBECTOMY-STENT-PLACEMENT

CPT 36906: Dialysis Circuit Thrombectomy with Angioplasty and Stent

CPT-36907-DIALYSIS-ACCESS-BALLOON-ANGIOPLASTY-CENTRAL-SEGMENT

CPT 36907: Dialysis Access Balloon Angioplasty, Central Segment

CPT-36908-DIALYSIS-CIRCUIT-INTRAVASCULAR-STENT-PLACEMENT

CPT 36908: Intravascular Stent Placement for Dialysis Circuit

CPT-36909-DIALYSIS-CIRCUIT-ENDOVASCULAR-OCCLUSION-EMBOLIZATION

CPT 36909: Permanent Endovascular Occlusion or Embolization of Dialysis Circuit

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 36904: Dialysis Circuit Thrombectomy and Pharmacologic Thrombolysis

Sign up for cpt 36904 policy alerts

Billing Code Overview

Catch payer policy changes before they impact reimbursement

Catch payer policy changes before they impact reimbursement

OpenPayer

CPT 36904: Dialysis Circuit Thrombectomy and Pharmacologic Thrombolysis

Sign up for cpt 36904 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 36904: Dialysis Circuit Thrombectomy and Pharmacologic Thrombolysis

Sign up for cpt 36904 policy alerts

Billing Code Overview

CPT 36904: Dialysis Circuit Thrombectomy and Pharmacologic Thrombolysis

Sign up for cpt 36904 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 36904 represent and where is it typically performed?

Which related CPT codes might be reported alongside 36904?

Which diagnosis codes are relevant when billing CPT 36904?

What modifiers are commonly noted for use with CPT 36904?

Which specialties and payers are referenced for CPT 36904?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 36904 represent and where is it typically performed?

Which related CPT codes might be reported alongside 36904?

Which diagnosis codes are relevant when billing CPT 36904?

What modifiers are commonly noted for use with CPT 36904?

Which specialties and payers are referenced for CPT 36904?

References