CPT 36400
Global XXX ActiveVnpnxr<3yrs phy/qhp fem/jug
CPT 36400 Billing & Documentation Guide
CPT code 36400 (Vnpnxr<3yrs phy/qhp fem/jug) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.37, a non-facility practice expense RVU of 0.43, and a malpractice RVU of 0.02, a total non-facility RVU of 0.82 and facility RVU of 0.47. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $28.17, though rates vary from $25.04 to $34.79 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 36400, 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 36400 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 1 units of 36400 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 36400
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.37 | 0.37 |
| Practice Expense RVU | 0.43 | 0.08 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 0.82 | 0.47 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 36400
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 | $30.16 | $16.33 | $28.67 - $34.79 | 29 |
| Florida | $28.07 | $16.34 | $27.09 - $29 | 3 |
| Georgia | $26.88 | $15.73 | $25.97 - $27.79 | 2 |
| Illinois | $27.56 | $16.26 | $26.52 - $28.41 | 4 |
| Michigan | $26.79 | $15.81 | $26.23 - $27.34 | 2 |
| North Carolina | $26.19 | $15.28 | $26.19 - $26.19 | 1 |
| New York | $29.88 | $16.83 | $26.47 - $31.47 | 5 |
| Ohio | $26.14 | $15.47 | $26.14 - $26.14 | 1 |
| Pennsylvania | $27.25 | $15.8 | $26.17 - $28.33 | 2 |
| Texas | $27.19 | $15.68 | $26.05 - $28.17 | 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 36400
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 36400 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | 9 | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | 9 | Misuse of Column Two code with Column One code |
| 0543T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0544T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0548T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0567T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0568T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0569T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0570T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0571T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 36400
What does CPT code 36400 mean? +
CPT code 36400 represents: Vnpnxr<3yrs phy/qhp fem/jug. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of XXX.
What is the Medicare reimbursement for CPT 36400? +
The 2026 Medicare national average non-facility payment for CPT 36400 is $28.17. Rates range from $25.04 to $34.79 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 36400? +
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 36400? +
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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