CPT 36223
Global 000 ActivePlace cath carotid/inom art
CPT 36223 Billing & Documentation Guide
CPT code 36223 (Place cath carotid/inom art) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 5.61, a non-facility practice expense RVU of 50.03, and a malpractice RVU of 1.71, a total non-facility RVU of 57.35 and facility RVU of 8.9. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1984.05, though rates vary from $1652.22 to $2648.25 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 36223, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 36223 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 36223 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 36223
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 5.61 | 5.61 |
| Practice Expense RVU | 50.03 | 1.58 |
| Malpractice RVU | 1.71 | 1.71 |
| Total RVU | 57.35 | 8.9 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 36223
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $2202.38 | $287.51 | $2052.65 - $2648.25 | 29 |
| Florida | $1975.18 | $351.51 | $1870.74 - $2071.38 | 3 |
| Georgia | $1850.18 | $306.34 | $1746.03 - $1954.32 | 2 |
| Illinois | $1911.83 | $348.17 | $1802.32 - $2006.06 | 4 |
| Michigan | $1836.89 | $317.32 | $1777.53 - $1896.24 | 2 |
| North Carolina | $1782.96 | $273.11 | $1782.96 - $1782.96 | 1 |
| New York | $2138.14 | $332.79 | $1815.03 - $2292.31 | 5 |
| Ohio | $1770.62 | $293.13 | $1770.62 - $1770.62 | 1 |
| Pennsylvania | $1886.91 | $301.82 | $1775.37 - $1998.45 | 2 |
| Texas | $1886.61 | $293.42 | $1761.09 - $2006.33 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 36223
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 36223 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 01916 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01924 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01925 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01926 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 36223
What does CPT code 36223 mean? +
CPT code 36223 represents: Place cath carotid/inom art. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 000.
What is the Medicare reimbursement for CPT 36223? +
The 2026 Medicare national average non-facility payment for CPT 36223 is $1984.05. Rates range from $1652.22 to $2648.25 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 36223? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 36223? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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