Summary & Overview
CPT 36906: Transluminal Balloon Angioplasty for Dialysis Access
CPT code 36906 represents transluminal balloon angioplasty of the peripheral dialysis segment, including all imaging and radiological supervision within the dialysis circuit, specifically addressing the central dialysis segment. This procedure is essential for maintaining functional dialysis access in patients with end-stage renal disease, helping to prevent complications and ensure ongoing treatment. Nationally, this code is relevant for vascular surgeons, interventional radiologists, and cardiothoracic vascular specialists who manage dialysis access.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides an overview of clinical indications, typical sites of service, and associated billing practices. Readers will gain insight into current policy updates, reimbursement benchmarks, and the clinical context for the use of 36906. The summary also highlights common modifiers and related codes, offering a comprehensive view of how this procedure fits within the broader landscape of dialysis access management and vascular interventions.
CPT Code Overview
CPT code 36906 describes a transluminal balloon angioplasty performed on the peripheral dialysis segment, including all necessary imaging and radiological supervision and interpretation within the dialysis circuit, specifically targeting the central dialysis segment. This procedure is classified under vascular surgery and is typically conducted in an outpatient hospital setting (Place of Service 22). It is a critical intervention for patients with dialysis access issues, aiming to restore or improve blood flow in the dialysis circuit to ensure effective renal replacement therapy.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an individual with end stage renal disease who is dependent on regular hemodialysis. The patient presents with decreased dialysis efficiency, often due to stenosis or stricture within the central segment of their dialysis circuit, which may include vascular prosthetic devices, implants, or grafts. The vascular surgeon or interventional radiologist evaluates the patient and determines that a transluminal balloon angioplasty is necessary to restore adequate blood flow. The procedure is performed in an outpatient hospital setting, where imaging and radiological supervision are included to guide the angioplasty within the central dialysis segment.
Coding Specifications
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Modifiers:
26: Professional Component – Used when only the physician's professional services are billed, excluding the technical component.TC: Technical Component – Used when only the technical portion (equipment, supplies, and technical staff) is billed.59: Distinct Procedural Service – Used to indicate that a procedure or service is distinct or independent from other services performed on the same day.51: Multiple Procedures – Used when multiple procedures are performed during the same session.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
2086S0129X | Vascular Surgery Physician |
208C00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
207V00000X | Vascular & Interventional Radiology |
These taxonomies represent providers specializing in vascular surgery, cardiothoracic vascular surgery, and interventional radiology, all of whom may perform or supervise this procedure.
Related Diagnoses
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T82.858A: Stenosis of vascular prosthetic devices, implants and grafts, initial encounter- Indicates narrowing of a vascular prosthetic device or graft, often necessitating angioplasty to restore patency.
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I77.1: Stricture of artery- Represents arterial narrowing, which can compromise dialysis access and require intervention.
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N18.6: End stage renal disease- Identifies patients with advanced kidney failure, who are typically dependent on dialysis and at risk for access complications.
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Z99.2: Dependence on renal dialysis- Denotes patients reliant on dialysis, highlighting the importance of maintaining functional vascular access.
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I70.92: Atherosclerosis of unspecified type of bypass graft(s) of the extremities- Refers to atherosclerotic changes in bypass grafts, which may contribute to stenosis and require angioplasty.
Related CPT Codes
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36901: Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all imaging and radiological supervision and interpretation necessary to perform the angiography.- Used for diagnostic imaging of the dialysis circuit prior to intervention.
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36902: Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography and percutaneous transluminal angioplasty of the peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty.- Used when angioplasty is performed in the peripheral segment of the dialysis circuit.
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36907: Transluminal balloon angioplasty, central dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the dialysis circuit.- Similar to
36906, but may differ in segment or technique; often used as an alternative or in conjunction depending on the clinical scenario.
- Similar to
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36908: Transluminal balloon angioplasty, central dialysis segment, with stent placement, including all imaging and radiological supervision and interpretation necessary to perform the stent placement within the dialysis circuit.- Used when stent placement is required in addition to angioplasty.
These codes are related to the workflow of evaluating and treating stenosis or stricture in dialysis circuits. 36901 is commonly used for diagnostic purposes, while 36902, 36906, 36907, and 36908 represent escalating interventions from angioplasty in peripheral or central segments to stent placement.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT 36906 is $6,186.44, which is notably higher than the BUCA (average commercial) mean rate of $4,916.20. Among commercial payers, UnitedHealth Group stands out with the highest mean rate at $7,773.95, while Aetna is the lowest at $3,282.01.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Aetna has the tightest range ($1,786.00), indicating less variability in rates, while UnitedHealth Group exhibits the widest range ($3,755.00), reflecting greater variability. Medicare's range is $840.00, showing relatively consistent rates compared to most commercial payers.
The table and chart below present a full breakdown of national benchmarks for each payer, including mean rates and percentile values.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.