CPT 36831
Global 090 ActiveOpen thrombect av fistula
CPT 36831 Billing & Documentation Guide
CPT code 36831 (Open thrombect av fistula) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 10.73, a non-facility practice expense RVU of 3.46, and a malpractice RVU of 2.75, a total non-facility RVU of 16.94 and facility RVU of 16.94. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $564.95, though rates vary from $497.4 to $711.28 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 36831, 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 36831 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 36831 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 36831
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 10.73 | 10.73 |
| Practice Expense RVU | 3.46 | 3.46 |
| Malpractice RVU | 2.75 | 2.75 |
| Total RVU | 16.94 | 16.94 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 36831
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 | $557.8 | $557.8 | $540.38 - $613.7 | 29 |
| Florida | $653.15 | $653.15 | $606.93 - $710.99 | 3 |
| Georgia | $579.09 | $579.09 | $570.97 - $587.2 | 2 |
| Illinois | $646.84 | $646.84 | $607.47 - $687.85 | 4 |
| Michigan | $596.19 | $596.19 | $567.61 - $624.78 | 2 |
| North Carolina | $524.91 | $524.91 | $524.91 - $524.91 | 1 |
| New York | $629.19 | $629.19 | $532.75 - $689.31 | 5 |
| Ohio | $556.49 | $556.49 | $556.49 - $556.49 | 1 |
| Pennsylvania | $573.01 | $573.01 | $551.28 - $594.73 | 2 |
| Texas | $559.46 | $559.46 | $547.43 - $602.41 | 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 36831
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 36831 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 01844 | 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 | Misuse of Column Two code with Column One code |
| 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 | 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 |
Frequently Asked Questions, CPT 36831
What does CPT code 36831 mean? +
CPT code 36831 represents: Open thrombect av fistula. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 090.
What is the Medicare reimbursement for CPT 36831? +
The 2026 Medicare national average non-facility payment for CPT 36831 is $564.95. Rates range from $497.4 to $711.28 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 36831? +
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 36831? +
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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