CPT 36904
Global 000 ActiveThrmbc/nfs dialysis circuit
CPT 36904 Billing & Documentation Guide
CPT code 36904 (Thrmbc/nfs dialysis circuit) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 7.31, a non-facility practice expense RVU of 43.68, and a malpractice RVU of 1.13, a total non-facility RVU of 52.12 and facility RVU of 9.6. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1804.07, though rates vary from $1516.84 to $2395.06 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 36904, 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 36904 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 36904 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 36904
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 7.31 | 7.31 |
| Practice Expense RVU | 43.68 | 1.16 |
| Malpractice RVU | 1.13 | 1.13 |
| Total RVU | 52.12 | 9.6 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 36904
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 | $1999.72 | $319.22 | $1867.55 - $2395.06 | 29 |
| Florida | $1781.45 | $356.51 | $1695.65 - $1858.38 | 3 |
| Georgia | $1681.53 | $326.65 | $1590.53 - $1772.52 | 2 |
| Illinois | $1726.86 | $354.58 | $1635.18 - $1811.09 | 4 |
| Michigan | $1667.24 | $333.66 | $1618.79 - $1715.68 | 2 |
| North Carolina | $1629.48 | $304.43 | $1629.48 - $1629.48 | 1 |
| New York | $1934.66 | $350.27 | $1656.7 - $2064.57 | 5 |
| Ohio | $1614.23 | $317.58 | $1614.23 - $1614.23 | 1 |
| Pennsylvania | $1715.75 | $324.66 | $1619.15 - $1812.35 | 2 |
| Texas | $1716.9 | $318.71 | $1606.87 - $1821.66 | 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 36904
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 36904 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 |
| 01916 | 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 | Anesthesia service included in surgical procedure |
| 01925 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01926 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01930 | Column 1 (primary), can be billed with modifier | Yes | Anesthesia service included in surgical procedure |
| 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 | Misuse of Column Two code with Column One code |
| 0230T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 36904
What does CPT code 36904 mean? +
CPT code 36904 represents: Thrmbc/nfs dialysis circuit. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 000.
What is the Medicare reimbursement for CPT 36904? +
The 2026 Medicare national average non-facility payment for CPT 36904 is $1804.07. Rates range from $1516.84 to $2395.06 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 36904? +
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 36904? +
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 April 17, 2026.
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