CPT 36251
Global 000 ActiveIns cath ren art 1st unilat
CPT 36251 Billing & Documentation Guide
CPT code 36251 (Ins cath ren art 1st unilat) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 4.97, a non-facility practice expense RVU of 30.79, and a malpractice RVU of 0.95, a total non-facility RVU of 36.71 and facility RVU of 6.72. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1269.84, though rates vary from $1065.75 to $1684.24 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 36251, 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 36251 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 36251 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 36251
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 4.97 | 4.97 |
| Practice Expense RVU | 30.79 | 0.8 |
| Malpractice RVU | 0.95 | 0.95 |
| Total RVU | 36.71 | 6.72 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 36251
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 | $1406.05 | $220.78 | $1312.97 - $1684.24 | 29 |
| Florida | $1259.61 | $254.58 | $1196.86 - $1316.83 | 3 |
| Georgia | $1185.33 | $229.71 | $1121.17 - $1249.48 | 2 |
| Illinois | $1220.93 | $253.04 | $1154.54 - $1279.57 | 4 |
| Michigan | $1176.35 | $235.76 | $1140.77 - $1211.92 | 2 |
| North Carolina | $1145.79 | $211.21 | $1145.79 - $1145.79 | 1 |
| New York | $1364.31 | $246.82 | $1165.3 - $1458.33 | 5 |
| Ohio | $1136.93 | $222.38 | $1136.93 - $1136.93 | 1 |
| Pennsylvania | $1208.75 | $227.59 | $1140.07 - $1277.42 | 2 |
| Texas | $1208.86 | $222.7 | $1131.34 - $1282.51 | 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 36251
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 36251 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 | 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 | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0230T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 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 |
Frequently Asked Questions, CPT 36251
What does CPT code 36251 mean? +
CPT code 36251 represents: Ins cath ren art 1st unilat. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 000.
What is the Medicare reimbursement for CPT 36251? +
The 2026 Medicare national average non-facility payment for CPT 36251 is $1269.84. Rates range from $1065.75 to $1684.24 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 36251? +
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 36251? +
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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