CPT 36420
Global XXX ActiveVenipuncture cutdown < 1 yr
CPT 36420 Billing & Documentation Guide
CPT code 36420 (Venipuncture cutdown < 1 yr) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.98, a non-facility practice expense RVU of 0.16, and a malpractice RVU of 0.24, a total non-facility RVU of 1.38 and facility RVU of 1.38. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $45.84, though rates vary from $40.32 to $59.21 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 36420, 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 36420 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 2 units of 36420 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 36420
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.98 | 0.98 |
| Practice Expense RVU | 0.16 | 0.16 |
| Malpractice RVU | 0.24 | 0.24 |
| Total RVU | 1.38 | 1.38 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 36420
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 | $44.58 | $44.58 | $43.44 - $48.34 | 29 |
| Florida | $53.7 | $53.7 | $49.89 - $58.57 | 3 |
| Georgia | $47.48 | $47.48 | $47.06 - $47.89 | 2 |
| Illinois | $53.33 | $53.33 | $50.14 - $56.73 | 4 |
| Michigan | $49.04 | $49.04 | $46.66 - $51.41 | 2 |
| North Carolina | $42.84 | $42.84 | $42.84 - $42.84 | 1 |
| New York | $51.15 | $51.15 | $43.45 - $56.07 | 5 |
| Ohio | $45.69 | $45.69 | $45.69 - $45.69 | 1 |
| Pennsylvania | $46.83 | $46.83 | $45.21 - $48.45 | 2 |
| Texas | $45.62 | $45.62 | $44.54 - $49.33 | 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 36420
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 36420 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 36420
What does CPT code 36420 mean? +
CPT code 36420 represents: Venipuncture cutdown < 1 yr. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of XXX.
What is the Medicare reimbursement for CPT 36420? +
The 2026 Medicare national average non-facility payment for CPT 36420 is $45.84. Rates range from $40.32 to $59.21 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 36420? +
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 36420? +
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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