CPT 36245
Global XXX ActiveIns cath abd/l-ext art 1st
CPT 36245 Billing & Documentation Guide
CPT code 36245 (Ins cath abd/l-ext art 1st) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 4.53, a non-facility practice expense RVU of 30.5, and a malpractice RVU of 0.86, a total non-facility RVU of 35.89 and facility RVU of 6.2. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1242.16, though rates vary from $1041.19 to $1652.35 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 36245, 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 36245 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 6 units of 36245 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 36245
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 4.53 | 4.53 |
| Practice Expense RVU | 30.5 | 0.81 |
| Malpractice RVU | 0.86 | 0.86 |
| Total RVU | 35.89 | 6.2 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 36245
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 | $1377.74 | $204.32 | $1285.8 - $1652.35 | 29 |
| Florida | $1229.35 | $234.37 | $1168.38 - $1284.45 | 3 |
| Georgia | $1157.77 | $211.72 | $1094.25 - $1221.29 | 2 |
| Illinois | $1191.08 | $232.87 | $1126.3 - $1249.5 | 4 |
| Michigan | $1148.32 | $217.14 | $1113.83 - $1182.81 | 2 |
| North Carolina | $1120.13 | $194.9 | $1120.13 - $1120.13 | 1 |
| New York | $1334.03 | $227.71 | $1139.29 - $1425.6 | 5 |
| Ohio | $1110.36 | $204.96 | $1110.36 - $1110.36 | 1 |
| Pennsylvania | $1181.22 | $209.88 | $1113.64 - $1248.79 | 2 |
| Texas | $1181.76 | $205.46 | $1105.03 - $1254.87 | 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 36245
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 36245 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 | Misuse of Column Two code with Column One code |
| 01925 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 01926 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0213T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 34713 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 34714 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 34812 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 34813 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 36245
What does CPT code 36245 mean? +
CPT code 36245 represents: Ins cath abd/l-ext art 1st. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of XXX.
What is the Medicare reimbursement for CPT 36245? +
The 2026 Medicare national average non-facility payment for CPT 36245 is $1242.16. Rates range from $1041.19 to $1652.35 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 36245? +
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 36245? +
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 June 2, 2026.
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