CPT 36406
Global XXX ActiveVnpnxr<3yrs phy/qhp other vn
CPT 36406 Billing & Documentation Guide
CPT code 36406 (Vnpnxr<3yrs phy/qhp other vn) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.18, a non-facility practice expense RVU of 0.36, and a malpractice RVU of 0.01, a total non-facility RVU of 0.55 and facility RVU of 0.23. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $18.97, though rates vary from $16.51 to $24.19 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 36406, 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 36406 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 36406 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 36406
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.18 | 0.18 |
| Practice Expense RVU | 0.36 | 0.04 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 0.55 | 0.23 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 36406
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 | $20.64 | $7.99 | $19.47 - $24.19 | 29 |
| Florida | $18.73 | $8 | $18.01 - $19.37 | 3 |
| Georgia | $17.9 | $7.7 | $17.14 - $18.65 | 2 |
| Illinois | $18.29 | $7.96 | $17.51 - $19 | 4 |
| Michigan | $17.78 | $7.74 | $17.37 - $18.18 | 2 |
| North Carolina | $17.44 | $7.47 | $17.44 - $17.44 | 1 |
| New York | $20.16 | $8.24 | $17.67 - $21.31 | 5 |
| Ohio | $17.33 | $7.57 | $17.33 - $17.33 | 1 |
| Pennsylvania | $18.21 | $7.73 | $17.37 - $19.04 | 2 |
| Texas | $18.19 | $7.67 | $17.26 - $19.04 | 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 36406
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 36406 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 36406
What does CPT code 36406 mean? +
CPT code 36406 represents: Vnpnxr<3yrs phy/qhp other vn. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of XXX.
What is the Medicare reimbursement for CPT 36406? +
The 2026 Medicare national average non-facility payment for CPT 36406 is $18.97. Rates range from $16.51 to $24.19 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 36406? +
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 36406? +
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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