Surgical · General

Therapeutic apheresis procedure targeting platelet depletion (plateletpheresis) in a patient with a pathologic excess of circulating platelets.

Verified May 8, 2026 · 5 sources ↓

Medicare: $88.18
Work RVU: 1.95
Global, days: 0
Region: General

Drawn from CMSTerumobctUhcproviderCgsmedicare

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Diagnosis driving platelet depletion (e.g., essential thrombocythemia, reactive thrombocytosis) with corresponding ICD-10 code
Physician order specifying therapeutic plateletpheresis and clinical indication
Platelet count before and after the procedure to demonstrate medical necessity and response
Documentation that this is a therapeutic (patient treatment) procedure, not donor platelet collection
If same-day E/M is billed, documentation that the visit addressed a separately identifiable problem with a distinct diagnosis

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 26 Professional component 52 Reduced services 76 Repeat, same physician 77 Repeat, another physician

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 36513 describes therapeutic plateletpheresis — an extracorporeal procedure that selectively removes platelets from a patient's blood to treat conditions such as thrombocythemia or extreme thrombocytosis. Blood is drawn, passed through an apheresis device that isolates and removes platelets, and the remaining components are returned to the patient. This is a therapeutic intervention, not a donor collection procedure; 36513 does not apply to collecting donor platelets for transfusion.

The code carries a 000-day global period, meaning each session is billed independently with no bundled pre- or post-procedure care attached. In the outpatient hospital setting, CMS assigns this to APC 5241 (Level 1 Blood Product Exchange). A physician may bill a same-day E/M only when the visit is for a separately identifiable service tied to a different diagnosis — append modifier 25 to the E/M in that scenario.

UnitedHealthcare's 2026 commercial policy lists specific covered diagnoses for therapeutic apheresis. Thrombocytosis and related platelet-excess conditions must be clearly documented with supporting ICD-10 codes to clear medical necessity review. Payers vary on whether prior authorization is required per session or per treatment course; verify before scheduling.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (1.95) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (2.64) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.95
Practice expense RVU	0.53
Malpractice RVU	0.16
Total RVU	2.64
Medicare national rate	$88.18
Global period	0 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$88.18
HOPD (APC 5241) Hospital outpatient department	$450.73
ASC (PI R2) Ambulatory surgical center (freestanding)	$244.40

Common denial reasons

The recurring reasons claims for CPT 36513 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Medical necessity not established — payer requires specific covered diagnosis and 36513 is billed with an unsupported or vague ICD-10 code
Conflation with donor platelet collection — 36513 does not cover apheresis performed to collect platelets for transfusion to another patient
Same-day E/M denied when the visit note does not clearly separate it from the supervision of the apheresis procedure itself
Missing or expired prior authorization — many commercial payers require auth per treatment course for therapeutic apheresis
Bundling denial when billed alongside codes that are NCCI-edit column 2 components of the apheresis service without an appropriate modifier

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can 36513 be used when collecting platelets from a donor for transfusion?

No. CPT 36513 is strictly for therapeutic plateletpheresis in a patient being treated for a platelet excess condition. Donor platelet collection is a separate service and is not reported with this code.

02What global period applies to 36513?

000-day global. Each apheresis session bills independently. There is no bundled post-procedure care window, but services integral to the session itself are still included in the single encounter payment.

03Can a physician bill an E/M on the same day as supervising a 36513 procedure?

Yes, but only when the E/M is for a separately identifiable service tied to a different diagnosis from the one driving the apheresis. Append modifier 25 to the E/M code and document both conditions distinctly in the note.

04Which ICD-10 diagnoses support medical necessity for 36513?

Essential thrombocythemia (D47.3) and other thrombocytosis diagnoses are the primary drivers. UHC's 2026 policy and most commercial payers publish covered-diagnosis lists for therapeutic apheresis — confirm your payer's specific list before billing.

05Does 36513 require prior authorization?

Payer-variable. Medicare generally does not require prior auth for this code, but many commercial plans — including UnitedHealthcare — require authorization per course of therapeutic apheresis. Verify before the first session, not after.

06When is modifier 76 appropriate with 36513?

Use modifier 76 when the same physician performs a repeat therapeutic plateletpheresis session on the same calendar date. Document why a second session on the same day was medically necessary.

07How does site of service affect reimbursement for 36513?

There is a meaningful payment difference between the HOPD and ASC settings — see the Site of Service comparison table on this page. Perform the procedure in the setting that matches your authorization and the patient's clinical needs, and verify your contract rates for each setting.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the clinical indication for platelet depletion (diagnosis, current platelet count, prior treatment history), the treating physician's supervision role, and whether any separately identifiable E/M service was rendered for a distinct diagnosis on the same date. That documentation chain directly prevents the two most common denials: unsupported medical necessity and same-day E/M bundling.

See how Mira captures CPT 36513 documentation