Summary & Overview
CPT 36906: Transluminal Balloon Angioplasty for Dialysis Access
CPT code 36906 represents transluminal balloon angioplasty of the peripheral dialysis segment, including all imaging and radiological supervision within the dialysis circuit, specifically addressing the central dialysis segment. This procedure is essential for maintaining functional dialysis access in patients with end-stage renal disease, helping to prevent complications and ensure ongoing treatment. Nationally, this code is relevant for vascular surgeons, interventional radiologists, and cardiothoracic vascular specialists who manage dialysis access.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides an overview of clinical indications, typical sites of service, and associated billing practices. Readers will gain insight into current policy updates, reimbursement benchmarks, and the clinical context for the use of 36906. The summary also highlights common modifiers and related codes, offering a comprehensive view of how this procedure fits within the broader landscape of dialysis access management and vascular interventions.
CPT Code Overview
CPT code 36906 describes a transluminal balloon angioplasty performed on the peripheral dialysis segment, including all necessary imaging and radiological supervision and interpretation within the dialysis circuit, specifically targeting the central dialysis segment. This procedure is classified under vascular surgery and is typically conducted in an outpatient hospital setting (Place of Service 22). It is a critical intervention for patients with dialysis access issues, aiming to restore or improve blood flow in the dialysis circuit to ensure effective renal replacement therapy.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an individual with end stage renal disease who is dependent on regular hemodialysis. The patient presents with decreased dialysis efficiency, often due to stenosis or stricture within the central segment of their dialysis circuit, which may include vascular prosthetic devices, implants, or grafts. The vascular surgeon or interventional radiologist evaluates the patient and determines that a transluminal balloon angioplasty is necessary to restore adequate blood flow. The procedure is performed in an outpatient hospital setting, where imaging and radiological supervision are included to guide the angioplasty within the central dialysis segment.
Coding Specifications
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Modifiers:
26: Professional Component – Used when only the physician's professional services are billed, excluding the technical component.TC: Technical Component – Used when only the technical portion (equipment, supplies, and technical staff) is billed.59: Distinct Procedural Service – Used to indicate that a procedure or service is distinct or independent from other services performed on the same day.51: Multiple Procedures – Used when multiple procedures are performed during the same session.
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Provider Taxonomies: