How much does Medicare pay for CPT 36906?

Medicare allowed an average of $5934.78 per service and paid $4728.84 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $18,600, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 36906 pay differently in an office than a hospital?

Yes. The allowed amount averaged $5641.14 in an office setting and $6041.07 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 36906 most?

Ambulatory Surgical Center, with 1,612 services from 50 clinicians. Next are Nephrology, Interventional Radiology, Diagnostic Radiology.

CPT 36906

Removal and/or dissolving of blood clot in hemodialysis circuit and balloon dilation of dialysis segment and placement of stent with review by radiologist

$5934.78Medicare-allowed amount per service, averaged across 4,237 services

Providers submitted

$18,600

Asking price, not received

Medicare allowed

$5934.78

The fee schedule figure

Medicare paid

$4728.84

Balance is patient coinsurance

Providers submitted an average of $18,600 for this code and Medicare allowed $5934.78 — 3.1× 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 $4728.84 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $5641.14
Hospital / facility: $6041.07

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,126 services were billed in an office setting and 3,111 in a facility.

Services: 4,237
Beneficiaries: 3,575
Providers billing it: 157
Total allowed: $25,145,663

What Medicare pays for CPT 36906

Across 4,237 services billed by 157 providers to 3,575 beneficiaries, Medicare allowed an average of $5934.78 per service. That is 1.2 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 36906

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	1,612	1,336	$11,189	50
Nephrology	1,007	876	$2633.93	42
Interventional Radiology	759	644	$2484.39	33
Diagnostic Radiology	352	305	$2673.72	11
Vascular Surgery	250	193	$4567.31	9
General Surgery	105	90	$1166.00	6
Internal Medicine	83	70	$3928.67	4
Critical Care (Intensivists)	57	50	$575.80	1
General Practice	12	11	$524.53	1

36906 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	628	$6301.63	$4337.72	20
Texas	490	$5885.37	$4867.27	19
New Jersey	411	$5939.53	$4450.15	11
New York	379	$6498.02	$4405.62	13
Illinois	266	$5629.95	$4498.96	8
North Carolina	218	$6224.58	$5250.29	7
Pennsylvania	185	$6802.29	$5243.28	5
Florida	182	$5902.88	$4987.47	9
Virginia	169	$6415.49	$4859.02	5
Maryland	163	$6088.28	$4631.72	5
Tennessee	120	$4914.12	$4426.19	6
Rhode Island	94	$5814.56	$4609.90	2
Kansas	89	$5764.69	$4966.00	5
Indiana	88	$7199.08	$5860.45	4
Wisconsin	83	$8037.63	$6650.60	3
Georgia	77	$4526.61	$3549.89	4
Nevada	70	$7461.40	$5642.27	4
Arkansas	67	$5084.26	$4554.78	2
South Carolina	58	$2808.87	$2422.53	4
Michigan	50	$469.43	$382.41	2
Massachusetts	41	$2497.45	$1836.60	2
Connecticut	41	$5752.21	$4124.13	1
Alabama	36	$5203.91	$4615.50	2
Louisiana	35	$6237.21	$5455.57	2
Mississippi	30	$4611.71	$4044.03	2
Missouri	29	$4747.29	$4247.64	2
Washington	28	$6513.54	$4979.62	2
Arizona	28	$10,255	$8994.83	1
Ohio	21	$9822.86	$8934.48	1
Kentucky	20	$471.58	$387.18	1
Hawaii	17	$468.06	$385.58	1
Oklahoma	12	$467.01	$371.07	1
Guam	12	$5841.52	$4130.03	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
36905Removal and/or dissolving of blood clot in hemodialysis circuit and ba$2871.34
36903Insertion of needle and/or tube into hemodialysis circuit and insertio$3750.51

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.