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CPT 36906: Dialysis Circuit Thrombectomy with Angioplasty and Stent
CPT code 36906 represents a complex, image-guided endovascular procedure addressing thrombotic occlusion and focal stenosis within a dialysis circuit. The code bundles mechanical thrombectomy and/or pharmacologic thrombolysis with angioplasty and stent placement and includes diagnostic angiography and radiological supervision. Nationally, this procedure is critical for maintaining vascular access patency in patients receiving hemodialysis and has implications for patient morbidity, access longevity, and downstream resource use.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a clinical and billing-focused overview of the procedure coded by 36906, how it differs from closely related dialysis circuit angioplasty and stent codes, and common billing considerations. The publication outlines service setting expectations (hospital outpatient departments and ambulatory surgical centers), typical clinical indications such as dialysis circuit thrombosis and stenosis, and the inclusion of angiography and radiological interpretation in the service definition.
The content provides national-level benchmarks and policy context relevant to reimbursement and coding practice, highlights potential coding relationships with adjacent dialysis circuit codes, and summarizes implications for vascular access specialists, interventional radiologists, and facility billing teams. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 36906 describes a fluoroscopically guided thrombectomy and pharmacologic thrombolysis of a dialysis circuit vessel combined with dilation and stent placement of a narrowed segment. The procedure includes diagnostic angiography and radiological supervision and interpretation.
Service type: Interventional endovascular procedure combining mechanical thrombectomy and pharmacological thrombolysis with percutaneous transluminal angioplasty and stent placement.
Typical site of service: Hospital outpatient department or ambulatory surgical center with fluoroscopic imaging capability, performed under radiologic guidance.
National Reimbursement Benchmarks
Across national payers, Medicare's mean rate of $6,186.40 sits between BUCA's average commercial mean of $3,819.70 and several higher commercial payers; Medicare is roughly $2,366.70 higher than BUCA on average, signaling Medicare reimbursements are substantially above this commercial benchmark but below the highest commercial means. This positions Medicare nearer the middle of the national spectrum for CPT 36906 when compared to large commercial plans.
Dispersion measured as P75 minus P25 highlights variability: UnitedHealth Group shows the widest interquartile spread at $9,725.00 ($11,149.50 - $1,421.50), followed by Cigna at $7,471.60 and Blue Cross Blue Shield at $4,186.00. Aetna's spread is $4,986.00 and BUCA's is $5,551.50; Medicare is tight with a spread of $840.00 ($6,464 - $5,624). Thus UnitedHealth Group and Cigna display the greatest rate variability while Medicare is the tightest.