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    v1.0.30
    OpenPayerBilling CodesDialysis Circuit ProceduresCPT cpt-36904-dialysis-circuit-thrombectomy-thrombolysis
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    CPT 36904: Dialysis Circuit Thrombectomy with Pharmacologic Thrombolysis

    Medicare pays $1813 on average nationally for this procedure.

    CPT code 36904 describes fluoroscopically guided thrombectomy and/or pharmacologic thrombolytic injection performed through a catheter introduced into a vessel of a dialysis circuit, and includes diagnostic angiography and radiological supervision and interpretation; service type: endovascular thrombectomy/pharmacologic thrombolysis of dialysis circuit clot; typical site of service: interventional radiology suite or hospital outpatient department under fluoroscopic guidance.

    For related coverage guidance, see recent payer policy updates: Percutaneous Arteriovenous Fistula Creation, Dialysis Services (ESRD) Coverage and Provider Requirements, Total Parenteral Nutrition and Intradialytic Parenteral Nutrition.

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    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    75894Injection 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.
    36901Thrombolysis, open or percutaneous, dialysis circuit; including diagnostic angiography, radiological supervision and interpretation, initial thrombectomy/thrombolysisRelated dialysis access intervention codes for initial or simple access thrombectomy — may be used in conjunction or for different access types.
    36465Endovenous thermal ablation of incompetent vein, complete — single treatment areaMay be performed in the same vascular suite when venous interventions for access are required, though different clinical indications.
    76937Ultrasound guidance for vascular access requiring image documentation, percutaneous; unilateralOften used for ultrasound-guided needle or catheter placement into the dialysis circuit prior to fluoroscopic intervention.
    99152Moderate sedation services provided by the same physician performing the procedure, initial 15 minutesBilled when the physician providing the thrombectomy also administers and monitors moderate (conscious) sedation during the procedure.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207K00000X
    174400000X
    385HR2060X
    175L00000X
    3104A0630X
    374U00000X
    193200000X
    311500000X

    Related Payer Policy Updates

    Specialty: Dialysis/Renal Replacement1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Arteriovenous Fistula CreationAmeriHealth Caritas2026-08-01
    Dialysis Services (ESRD) Coverage and Provider RequirementsMississippi Division of Medicaid2026-08-01
    Total Parenteral Nutrition and Intradialytic Parenteral NutritionCentene2026-05-01
    End Stage Renal Disease (ESRD): Renal Dialysispriority health2026-02-01
    Dialysis services (acute and chronic hemodialysis and peritoneal dialysis)UnitedHealthcare2026-01-01
    Home Hemodialysis (HHD) Coverage Criteriasierra health and life2026-01-01
    Home Hemodialysis (HHD) — Coverage CriteriaUnitedHealthcare2026-01-01
    Staff-Assisted Home HemodialysisCigna2025-11-15
    Parsabiv (etelcalcetide) Coverage for Secondary HyperparathyroidismMolina Healthcare2025-10-09
    DefenCath (taurolidine/heparin catheter lock) CoverageMass General Brigham Health Plan2025-09-01

    Related Codes

    CPT-36901-DIALYSIS-CIRCUIT-CONTRAST-ANGIOGRAPHY-FLUOROSCOPIC-EVALUATION

    CPT 36901: Dialysis Circuit Angiography with Fluoroscopic Contrast

    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 Angioplasty

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

    CPT 36906: Dialysis Circuit Thrombectomy, Angioplasty, and Stent Placement

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

    CPT 36907: Balloon Angioplasty of Obstructed 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 of Dialysis Circuit

    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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