CPT 36473

How much did Medicare pay for CPT 36473 in Q1 2022? Copy link

Medicare paid $1,313.31 for CPT 36473 in the office (non-facility) setting and $181.34 in a facility under the Q1 2022 Physician Fee Schedule, effective January 2022. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. Across payment localities, the office amount is $1,120.98–$1,763.31 and the facility amount is $160.19–$237.32. This is a 8.9% decrease from the previous quarter.

Source: Physician relative value file (Q1 2022) · effective January 2022 · materially updated Aug 4, 2026 · compact facts

Rates by locality Copy link

The amounts above use GPCI 1.000, a national baseline no locality actually bills at. Medicare rescales every code by the local Geographic Practice Cost Indices before paying it, so what 36473 pays depends on where the service is furnished. Tap a state for its localities.

Office (non-facility) Facility

$1,121–$1,201 $1,201–$1,282 $1,282–$1,362 $1,362–$1,442 $1,442–$1,522 $1,522–$1,603

Highest-paying locality

$1,763.31

San Jose-Sunnyvale-Santa Clara (San Benito County), CA

Lowest-paying locality

$1,120.98

Mississippi, MS

36473 non-facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

San Jose, CA $1,759.07 Locality 01112-09 San Francisco, CA $1,694.66 Locality 01112-05 Queens, NY $1,625.13 Locality 13292-04 Long Island, NY $1,619.03 Locality 13202-02 Washington, DC $1,602.55 Locality 12202-01 New York City, NY $1,581.30 Locality 13202-01 Boston, MA $1,552.88 Locality 14212-01

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Northern New Jersey, NJ $1,550.92 Locality 12402-01 Seattle, WA $1,539.26 Locality 02402-02 Ventura County, CA $1,519.47 Locality 01182-17 Los Angeles, CA $1,518.06 Locality 01182-18 Anchorage, AK $1,502.86 Locality 02102-01 San Diego, CA $1,496.02 Locality 01182-72 Honolulu, HI $1,474.15 Locality 01212-01 Hartford, CT $1,449.52 Locality 13102-00 Baltimore, MD $1,436.18 Locality 12302-01 Philadelphia, PA $1,417.61 Locality 12502-01 Sacramento, CA $1,403.25 Locality 01112-63 Suburban Chicago, IL $1,398.20 Locality 06102-15 Riverside, CA $1,391.52 Locality 01112-62 Bakersfield, CA $1,387.30 Locality 01112-54 Chicago, IL $1,386.27 Locality 06102-16 Fresno, CA $1,383.22 Locality 01112-56 Portland, OR $1,378.84 Locality 02302-01 Miami, FL $1,377.96 Locality 09102-04 Austin, TX $1,371.59 Locality 04412-31 Providence, RI $1,371.52 Locality 14412-01 Denver, CO $1,362.97 Locality 04112-01 Houston, TX $1,348.76 Locality 04412-18 Dallas, TX $1,335.96 Locality 04412-11 Fort Lauderdale, FL $1,334.41 Locality 09102-03 Detroit, MI $1,324.22 Locality 08202-01 Las Vegas, NV $1,322.05 Locality 01312-00 Minneapolis, MN $1,313.50 Locality 06202-00 Atlanta, GA $1,308.74 Locality 10212-01 Richmond, VA $1,305.07 Locality 11302-00 Portland, ME $1,301.73 Locality 14112-03 Fort Worth, TX $1,298.71 Locality 04412-28 St. Louis, MO $1,282.68 Locality 05302-01 Metro East, IL $1,260.83 Locality 06102-12 Kansas City, MO $1,258.15 Locality 05302-02 Buffalo, NY $1,254.95 Locality 13282-99 Phoenix, AZ $1,252.71 Locality 03102-00 Tampa, FL $1,252.08 Locality 09102-99 San Antonio, TX $1,251.05 Locality 04412-99 New Orleans, LA $1,240.21 Locality 07202-01 Pittsburgh, PA $1,239.40 Locality 12502-99 Milwaukee, WI $1,229.18 Locality 06302-00 Charlotte, NC $1,224.94 Locality 11502-00 Salt Lake City, UT $1,213.96 Locality 03502-09 Columbus, OH $1,213.78 Locality 15202-00 Albuquerque, NM $1,195.58 Locality 04212-05 Wichita, KS $1,193.19 Locality 05202-00 Charleston, SC $1,192.84 Locality 11202-01 Des Moines, IA $1,191.26 Locality 05102-00 Omaha, NE $1,188.02 Locality 05402-00 Indianapolis, IN $1,184.00 Locality 08102-00 Birmingham, AL $1,180.55 Locality 10112-00 Nashville, TN $1,175.28 Locality 10312-35 Oklahoma City, OK $1,169.14 Locality 04312-00 Louisville, KY $1,156.16 Locality 15102-00 Boise, ID $1,155.98 Locality 02202-00

$160–$173 $173–$186 $186–$199 $199–$212 $212–$224 $224–$237

Highest-paying locality

$237.32

Alaska, AK

Lowest-paying locality

$160.19

Nebraska, NE

36473 facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

Anchorage, AK $237.32 Locality 02102-01 Queens, NY $235.07 Locality 13292-04 Long Island, NY $234.63 Locality 13202-02 Miami, FL $219.96 Locality 09102-04 New York City, NY $219.54 Locality 13202-01 Chicago, IL $204.49 Locality 06102-16 Washington, DC $203.43 Locality 12202-01

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Fort Lauderdale, FL $201.31 Locality 09102-03 Suburban Chicago, IL $196.04 Locality 06102-15 Detroit, MI $195.65 Locality 08202-01 Baltimore, MD $195.54 Locality 12302-01 Metro East, IL $194.51 Locality 06102-12 Northern New Jersey, NJ $193.69 Locality 12402-01 San Jose, CA $193.56 Locality 01112-09 Philadelphia, PA $191.69 Locality 12502-01 Boston, MA $191.12 Locality 14212-01 New Orleans, LA $190.88 Locality 07202-01 San Francisco, CA $190.28 Locality 01112-05 Las Vegas, NV $190.08 Locality 01312-00 Tampa, FL $189.16 Locality 09102-99 Hartford, CT $188.51 Locality 13102-00 Los Angeles, CA $188.00 Locality 01182-18 Seattle, WA $187.69 Locality 02402-02 Riverside, CA $185.97 Locality 01112-62 Providence, RI $185.22 Locality 14412-01 Ventura County, CA $184.88 Locality 01182-17 Houston, TX $183.97 Locality 04412-18 San Diego, CA $182.93 Locality 01182-72 Bakersfield, CA $181.75 Locality 01112-54 Albuquerque, NM $181.33 Locality 04212-05 Honolulu, HI $180.31 Locality 01212-01 Columbus, OH $180.29 Locality 15202-00 Sacramento, CA $179.59 Locality 01112-63 Atlanta, GA $179.04 Locality 10212-01 Richmond, VA $178.76 Locality 11302-00 St. Louis, MO $177.87 Locality 05302-01 Denver, CO $177.80 Locality 04112-01 Fresno, CA $177.67 Locality 01112-56 Kansas City, MO $177.12 Locality 05302-02 Pittsburgh, PA $176.48 Locality 12502-99 Phoenix, AZ $176.21 Locality 03102-00 Portland, OR $175.55 Locality 02302-01 Birmingham, AL $175.36 Locality 10112-00 Dallas, TX $174.56 Locality 04412-11 Charlotte, NC $174.47 Locality 11502-00 Buffalo, NY $173.92 Locality 13282-99 Salt Lake City, UT $173.68 Locality 03502-09 Portland, ME $173.16 Locality 14112-03 Austin, TX $172.83 Locality 04412-31 Louisville, KY $172.47 Locality 15102-00 Fort Worth, TX $172.40 Locality 04412-28 Oklahoma City, OK $171.88 Locality 04312-00 Charleston, SC $170.67 Locality 11202-01 San Antonio, TX $170.02 Locality 04412-99 Minneapolis, MN $166.82 Locality 06202-00 Nashville, TN $165.56 Locality 10312-35 Wichita, KS $165.36 Locality 05202-00 Indianapolis, IN $165.23 Locality 08102-00 Des Moines, IA $164.56 Locality 05102-00 Boise, ID $163.24 Locality 02202-00 Milwaukee, WI $162.87 Locality 06302-00 Omaha, NE $160.19 Locality 05402-00

Look up your exact locality →

Q1 2022 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range — its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.

How this amount is computed Copy link

CPT 36473 has a work RVU of 3.50, a non-facility practice expense RVU of 33.78, a facility practice expense RVU of 1.07 and a malpractice RVU of 0.67 — for total non-facility RVUs of 37.95 and total facility RVUs of 5.24 in the Q1 2022 release.

amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.

Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.

What does 36473 cost? Copy link

Four numbers get called the cost of a code. Each answers a different question.

National Q1 2022 figures at GPCI 1.000. Adjust for your locality and sequestration, or see the questions below for each figure in full.

Common questions Copy link

Applicable payment rules Copy link

Only the rules that can matter for 36473, each linking to its detail on this page.

Global period: what 36473's fee already covers Copy link

The fee covers pre-operative and post-operative work on the day of the procedure only — there is no follow-up window afterward. A visit the next day is separately payable.

A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.

Billing policy Copy link

What 36473's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code. See modifier amounts below for the dollar figures these support.

Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link

National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.

These apply standard MPFS percentages — assistant surgeon 16%, co-surgeon 62.5%, bilateral 150% — to the national non-facility amount above, so its source citation covers them too. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 36473.

See every current NCCI pair for 36473 →

Rate history by release Copy link

National non-facility amount for 36473 across quarterly releases. -22.9% decrease since Q1 2017 · high $1,541.50 in Q1 2018

Contracted rate: % of Medicare Copy link

Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what 36473 pays at that rate — $1,313.31 is 100%.

We want to build this: store your multipliers once, and every code page shows your rate instead of Medicare's. Tell us if you'd use it →

See how to find your contract's actual percentage.

How often 36473 is billed Copy link

Across Original Medicare in CY2024, 36473 ranked #2,622 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 1.6 times on average that year.

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q1 2022 fee schedule above.