Surgical · General

Placement of a needle directly into the bone marrow cavity to establish intraosseous access for drug or fluid infusion when conventional IV access cannot be obtained.

Verified May 8, 2026 · 6 sources ↓

Medicare: $57.78
Work RVU: 1.17
Global, days: 0
Region: General

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the IO access site (tibia, humerus, sternum, etc.) by anatomic location in the procedure note
Document the clinical indication for IO access — why conventional IV access was not feasible or was contraindicated
Record the substance(s) infused through the IO needle, including drug name, dose, and route confirmation
Note the provider who performed the needle placement, especially when distinct from the primary proceduralist
If performed concurrent with a major surgical procedure, document that IO placement was a separate, medically necessary intervention and not simply the anesthetic or antibiotic delivery route inherent to the primary case

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 36680 covers needle insertion into the bone marrow cavity for intraosseous (IO) infusion — the route of choice when peripheral IV access fails or is impractical. The code appears most often on claims from orthopedic surgeons and critical care intensivists, reflecting two distinct clinical contexts: perioperative antibiotic delivery during joint arthroplasty and emergent vascular access in critically ill patients.

The global period is 000, meaning no pre- or post-op work is bundled — the code covers the insertion encounter only. When 36680 is reported alongside a major surgical procedure such as a total joint arthroplasty, payers scrutinize whether the IO access was a separately necessary, documented service or simply the route used to administer a drug that is already captured elsewhere. The AAPC coding community has flagged this exact scenario: surgeons billing 36680 for antibiotic IO injection at the time of TKA or THA need clear documentation that the IO needle placement itself was a distinct, medically necessary act beyond the primary procedure.

NCCI bundling edits govern what can and cannot be billed alongside vascular access codes. Check current NCCI PTP edits before stacking 36680 with infusion administration codes on the same claim. The HOPD payment sits at $456.40 under CMS Physician Fee Schedule 2026; there is no ASC payment rate assigned.

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 (1.17) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (1.73) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.17
Practice expense RVU	0.33
Malpractice RVU	0.23
Total RVU	1.73
Medicare national rate	$57.78
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	$57.78
HOPD (APC 5735) Hospital outpatient department	$456.40

Common denial reasons

The recurring reasons claims for CPT 36680 get rejected.

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

Bundling into the primary surgical procedure (e.g., total joint arthroplasty) when IO access is not documented as a separately necessary service
Lack of documented rationale for why peripheral IV access was unavailable or contraindicated, causing medical necessity denial
Unbundling conflict with infusion administration codes billed on the same date without an NCCI-associated modifier
Missing or vague procedure note that fails to specify anatomic site and clinical context, triggering an audit-level documentation deficiency denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can 36680 be billed alongside a total knee or hip arthroplasty on the same date?

It can, but it requires explicit documentation that the IO needle placement was a separately necessary procedure — not just the route used to deliver a perioperative antibiotic or drug that is already part of the surgical service. Without that documentation, payers will bundle it into the primary procedure code.

02What global period applies to 36680?

The global period is 000 — no pre-op or post-op work is bundled. The code covers the insertion service on the date it is performed only.

03Does 36680 have an ASC payment rate?

No. CMS has not assigned an ASC facility payment rate for 36680. HOPD payment applies when the service is rendered in a hospital outpatient setting.

04Which modifier should I use if 36680 is performed on the same day as a surgical procedure by the same provider?

Modifier 59 (or its X-subset modifier XS if the payer accepts it) signals a distinct procedural service. Use it only when documentation supports that the IO placement was a separate and independent service from the primary procedure.

05Are there NCCI bundling edits that affect 36680?

Yes. NCCI PTP edits may bundle 36680 with infusion administration codes billed on the same date. Check the current CMS NCCI PTP edit tables before stacking 36680 with any administration or access codes to determine whether a modifier is permissible or the edit is not bypassable.

06Why do both orthopedic surgeons and intensivists commonly bill this code?

Orthopedic surgeons use IO access perioperatively — most often for antibiotic delivery when IV access is difficult. Intensivists use it for emergent vascular access in critically ill patients. The clinical context differs, but the code and documentation standards are the same.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the IO access site by name, the clinical justification for IO over peripheral IV, the substance infused, and the performing provider — from your dictation in real time. That level of specificity is what separates a clean claim from a bundling denial when 36680 appears on the same date as a major orthopedic procedure.

See how Mira captures CPT 36680 documentation