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CPT 36905: Dialysis Circuit Thrombectomy with Balloon Angioplasty and Angiography
CPT code 36905 covers fluoroscopy-guided percutaneous intervention for thrombotic occlusion and focal stenosis within a dialysis circuit, combining mechanical thrombectomy and/or pharmacologic thrombolysis with targeted balloon angioplasty and diagnostic angiography. This code represents a complex, image-guided vascular procedure that preserves or restores dialysis access, a critical component of care for patients undergoing hemodialysis. Nationally, timely and effective treatment of dialysis circuit thrombosis reduces catheter dependence and interruptions in dialysis therapy, with implications for patient outcomes and downstream costs.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of clinical context and coding scope for 36905, comparisons to adjacent procedure codes used for dialysis access intervention, and typical places of service where the procedure is performed. The publication outlines common billing considerations, including when diagnostic angiography and radiological supervision are bundled into the service, and highlights how 36905 fits into care pathways for thrombosed dialysis circuits.
The content is intended to inform coding staff, interventionalists, and revenue teams about the clinical and billing characterization of 36905, referencing related procedure concepts without making clinical recommendations. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 36905 describes a fluoroscopy-guided endovascular procedure in the dialysis circuit that combines clot removal and vessel reopening. The provider introduces a catheter into the dialysis circuit, performs mechanical thrombectomy to extract a clot, and/or administers pharmacologic thrombolytic injection to dissolve thrombus. The procedure also identifies a stenotic (narrowed) segment in the circuit and treats it by dilating the channel with an intravascular balloon (balloon angioplasty). The service includes diagnostic angiography and radiological supervision and interpretation as part of the procedural work.
Service type: Image-guided endovascular thrombectomy with angioplasty and diagnostic angiography
Typical site of service: Hospital-based interventional radiology or vascular surgery suite, or outpatient ambulatory surgery center with fluoroscopic capability
National Reimbursement Benchmarks
Nationally, Medicare’s mean rate of $2297.90 for CPT 36905 sits slightly above the BUCA commercial average of $2176.20, indicating Medicare pays near the commercial aggregate level for this code. The proximity of those means—about $121.70 apart—suggests limited separation between public program reimbursement and this commercial benchmark on a national basis.
Dispersion varies notably across payers when measured as P75 minus P25: Blue Cross Blue Shield has a range of $2,977.00, UnitedHealth Group $2,926.40, Cigna $2,438.00, BUCA $2,681.10, Aetna $1,805.20, and Medicare $286.00. This identifies Medicare as the tightest distribution and Blue Cross Blue Shield and UnitedHealth Group among the widest, with Aetna showing a moderate spread.