CPT 36470
Global 000 ActiveNjx sclrsnt 1 incmptnt vein
CPT 36470 Billing & Documentation Guide
CPT code 36470 (Njx sclrsnt 1 incmptnt vein) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.73, a non-facility practice expense RVU of 2.74, and a malpractice RVU of 0.15, a total non-facility RVU of 3.62 and facility RVU of 1.01. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $124.68, though rates vary from $105.58 to $161.72 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 36470, 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 36470 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 36470 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 36470
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.73 | 0.73 |
| Practice Expense RVU | 2.74 | 0.13 |
| Malpractice RVU | 0.15 | 0.15 |
| Total RVU | 3.62 | 1.01 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 36470
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 | $136.27 | $33.11 | $127.79 - $161.72 | 29 |
| Florida | $125.96 | $38.49 | $119.4 - $132.32 | 3 |
| Georgia | $117.73 | $34.56 | $111.99 - $123.46 | 2 |
| Illinois | $122.47 | $38.24 | $115.77 - $128.03 | 4 |
| Michigan | $117.38 | $35.51 | $113.6 - $121.15 | 2 |
| North Carolina | $112.97 | $31.64 | $112.97 - $112.97 | 1 |
| New York | $134.45 | $37.19 | $114.85 - $144.06 | 5 |
| Ohio | $112.99 | $33.4 | $112.99 - $112.99 | 1 |
| Pennsylvania | $119.6 | $34.21 | $113.13 - $126.07 | 2 |
| Texas | $119.27 | $33.45 | $112.32 - $125.7 | 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 36470
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 36470 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 | 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 | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 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 |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 36470
What does CPT code 36470 mean? +
CPT code 36470 represents: Njx sclrsnt 1 incmptnt vein. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 000.
What is the Medicare reimbursement for CPT 36470? +
The 2026 Medicare national average non-facility payment for CPT 36470 is $124.68. Rates range from $105.58 to $161.72 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 36470? +
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 36470? +
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 1, 2026.
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