How much does Medicare pay for CPT 36905?

Medicare allowed an average of $2871.34 per service and paid $2284.88 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $8743.95, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 36905 pay differently in an office than a hospital?

Yes. The allowed amount averaged $2356.26 in an office setting and $3068.72 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 36905 most?

Ambulatory Surgical Center, with 4,143 services from 92 clinicians. Next are Nephrology, Interventional Radiology, Vascular Surgery.

CPT 36905

Removal and/or dissolving of blood clot in hemodialysis circuit and balloon dilation of dialysis segment with imaging review by radiologist, with balloon tube

$2871.34Medicare-allowed amount per service, averaged across 12,153 services

Providers submitted

$8743.95

Asking price, not received

Medicare allowed

$2871.34

The fee schedule figure

Medicare paid

$2284.88

Balance is patient coinsurance

Providers submitted an average of $8743.95 for this code and Medicare allowed $2871.34 — 3.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $2284.88 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $2356.26
Hospital / facility: $3068.72

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 3,367 services were billed in an office setting and 8,786 in a facility.

Services: 12,153
Beneficiaries: 8,998
Providers billing it: 380
Total allowed: $34,895,395

What Medicare pays for CPT 36905

Across 12,153 services billed by 380 providers to 8,998 beneficiaries, Medicare allowed an average of $2871.34 per service. That is 1.4 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 36905

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	4,143	2,857	$6023.75	92
Nephrology	3,653	2,869	$1247.21	134
Interventional Radiology	1,498	1,207	$1085.35	47
Vascular Surgery	1,268	865	$1754.16	44
Diagnostic Radiology	938	723	$1033.37	35
Internal Medicine	329	228	$1191.84	13
General Surgery	244	186	$546.22	13
Critical Care (Intensivists)	45	34	$497.16	1
Emergency Medicine	35	29	$448.72	1

36905 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	2,135	$3013.86	$2036.68	59
Texas	1,658	$2813.44	$2350.14	49
New York	778	$2781.39	$1884.05	21
Maryland	698	$2984.00	$2305.77	15
Florida	651	$2777.76	$2318.47	21
New Jersey	554	$3143.98	$2321.02	14
Virginia	522	$3209.76	$2525.77	11
Pennsylvania	493	$3411.03	$2658.92	14
Illinois	469	$2907.76	$2307.85	20
Georgia	425	$3115.72	$2498.87	14
South Carolina	350	$1685.41	$1427.10	12
North Carolina	330	$2820.07	$2370.59	12
Indiana	279	$3154.94	$2564.96	10
Michigan	275	$2444.25	$2007.39	10
Tennessee	259	$2764.55	$2446.40	7
Alabama	256	$2418.34	$2239.86	11
Ohio	228	$3952.57	$3304.60	11
Nevada	187	$4179.80	$3211.17	6
Mississippi	173	$1387.52	$1205.84	7
Kansas	170	$3443.13	$2945.60	7
Arizona	168	$4409.65	$3661.81	5
Louisiana	167	$1261.21	$1079.57	8
Rhode Island	141	$3152.40	$2574.35	2
Missouri	119	$2561.98	$2089.45	4
Massachusetts	116	$1225.88	$900.79	4
Connecticut	101	$2164.07	$1572.12	4
Kentucky	95	$1285.87	$1026.07	4
Delaware	67	$2166.94	$1737.81	3
Oregon	65	$3885.17	$2799.25	3
Washington	57	$3608.76	$2630.35	2
Oklahoma	47	$399.18	$333.42	3
Arkansas	37	$3162.62	$2912.84	2
District of Columbia	25	$2450.87	$1732.53	1
Colorado	16	$2288.92	$1720.40	1
U.S. Virgin Islands	15	$420.97	$335.50	1
Hawaii	14	$393.56	$323.09	1
Minnesota	13	$409.51	$335.46	1

Related codes

36902Insertion of needle and/or tube into hemodialysis circuit and balloon$1145.95
36907Balloon dilation of dialysis segment$366.37
36901Insertion of needle and/or tube into hemodialysis circuit$388.29
36903Insertion of needle and/or tube into hemodialysis circuit and insertio$3750.51
36906Removal and/or dissolving of blood clot in hemodialysis circuit and ba$5934.78

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.