CPT Code 36590: Removal of Tunneled CVAD With Port

Key Takeaways

CPT 36590 codes removal of tunneled CVAD with subcutaneous port or pump

Facility RVU: 10.62 work + 5.11 PE; non-facility: 15.73 total

Documentation requires catheter type, insertion site, reason for removal

Differs from 36589 by presence of subcutaneous port or pump device

Pre-authorization often required; verify payer policy before scheduling

CPT code 36590 describes the removal of a tunneled central venous access device (CVAD) with a subcutaneous port or pump, regardless of whether the insertion was central or peripheral. This procedure code applies when a healthcare provider removes a long-term vascular access device that has been tunneled under the skin and includes an implanted port (such as a Port-a-Cath) or pump mechanism. The code captures the complete removal process, including extraction of both the catheter and the subcutaneous component.

Tunneled central venous catheters with ports serve patients requiring long-term intravenous therapy, such as chemotherapy administration, total parenteral nutrition, or frequent blood draws. When these devices reach the end of their functional life, develop complications, or are no longer medically necessary, removal becomes clinically indicated. Accurate coding and documentation of this procedure directly impact claim approval rates and reimbursement timing.

CPT Code 36590: Definition and Clinical Application

The American Medical Association defines CPT 36590 as “Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion.” This code specifically addresses devices where the catheter has been tunneled under the skin and terminates at a subcutaneous reservoir or pump. The tunneling process distinguishes these devices from non-tunneled catheters, which are coded differently.

Clinical scenarios requiring 36590 include port infections unresponsive to antibiotic therapy, catheter malfunction preventing proper medication delivery, thrombotic occlusion making the device unusable, and completion of long-term treatment protocols. Device removal may also become necessary when patients develop skin breakdown over the port site or experience mechanical complications such as catheter fracture. According to the AMA CPT code set overview, proper code selection depends on accurate identification of device components present at the time of removal.

Port-a-Cath devices represent the most common type of tunneled CVAD with subcutaneous port. These titanium or plastic reservoirs sit beneath the skin, typically on the upper chest wall, connected to a catheter that threads into a central vein. The port’s silicone septum allows needle access for medication administration without requiring repeated venipuncture. Removal requires surgical extraction of both the catheter and the implanted port body.

CPT 36590 vs CPT 36589: Critical Coding Distinction

CPT 36589 codes removal of tunneled CVADs without a subcutaneous port or pump. The distinction between these codes hinges entirely on whether the removed device includes an implanted reservoir component. Hickman catheters, Broviac catheters, and Groshong catheters without ports fall under 36589. The CPT 36589 coding guidelines clarify which device types require this code versus 36590.

Devices with attached ports, pumps, or subcutaneous injection chambers require 36590. Miscoding this distinction frequently triggers claim denials, particularly when payers conduct post-payment audits comparing operative notes to submitted codes.

Documentation must explicitly identify the removed device type. Phrases such as “Port-a-Cath removed,” “subcutaneous port excised,” or “implanted reservoir and catheter extracted” support 36590. Generic terms like “central line removed” or “CVAD extraction” without component specification create ambiguity that invites payer scrutiny. Claims management software with integrated coding validation can flag potential 36589/36590 confusion before claim submission.

Reimbursement and RVU Data for CPT Code 36590

According to the CMS Physician Fee Schedule, CPT 36590 carries distinct relative value units (RVUs) depending on place of service. Facility settings (hospital outpatient departments, ambulatory surgery centers) generate work RVUs of 10.62 and practice expense RVUs of 5.11, yielding facility total RVUs of 15.73. Non-facility settings show higher practice expense RVUs reflecting equipment and supply costs borne by the performing practice.

Medicare reimbursement varies by geographic location through the Geographic Practice Cost Index (GPCI). A procedure performed in Manhattan generates higher payment than the identical service in rural Montana due to GPCI adjustments for work, practice expense, and malpractice components. The 2026 Medicare conversion factor multiplies total RVUs to determine payment amounts. Commercial payers typically base their fee schedules on percentages of Medicare rates, ranging from 110% to 250% depending on contract negotiations.

Prior authorization requirements significantly impact the revenue cycle for 36590. Many commercial insurers require pre-procedure approval for port removals, particularly when the device has been in place for less than six months or when removal occurs outside standard treatment completion. Blue Cross NC CPT/HCPCS search tools allow providers to verify authorization requirements by entering the CPT code and patient insurance details.

Common Reimbursement Variables Affecting CPT 36590 Payment

Modifier usage alters reimbursement rates. Modifier 50 (bilateral procedure) does not apply to 36590 as port placement and removal occur unilaterally. Modifier 51 (multiple procedures) reduces payment when 36590 is performed alongside other separately reportable procedures during the same session. Modifier 59 (distinct procedural service) may become necessary when removal occurs during an encounter primarily focused on treating a complication, such as port site infection requiring separate incision and drainage.

Global period rules affect billing for post-removal care. CPT 36590 carries a 90-day global period under Medicare rules, meaning routine follow-up visits within three months are bundled into the procedure payment. Complications requiring additional intervention may warrant separate billing with modifier 24 (unrelated E/M service during postoperative period) or modifier 78 (return to operating room for related procedure). Practices must track global period end dates to avoid inadvertent billing violations.

Documentation Requirements for CPT 36590 Claims

Medical necessity documentation forms the foundation of successful 36590 claims. Operative notes must specify the clinical indication prompting removal, such as treatment completion, device malfunction, infection, or patient-reported complications. Generic phrases like “no longer needed” fail to establish medical necessity. Instead, documentation should reference specific symptoms, diagnostic findings, or treatment protocol conclusions that necessitated device extraction.

Anatomical detail separates compliant documentation from insufficient records. Notes must identify the catheter insertion site (subclavian, jugular, femoral), the vein accessed (superior vena cava, inferior vena cava), and the port location (right chest wall, left chest wall, upper arm). This anatomical specificity confirms the tunneled nature of the device and validates code selection. Photographs or diagrams supplement written descriptions, particularly when explaining complex anatomy or identifying previous surgical sites.

Procedural detail requirements include incision location, dissection technique, catheter mobilization method, and specimen description. Documentation should note whether the catheter was intact at removal or required piecemeal extraction due to fragmentation. Confirming complete device removal documentation, including all catheter segments and the entire subcutaneous port, protects against retained foreign body complications and supports the comprehensive nature of the procedure. AI-powered clinical documentation tools can prompt providers to include these essential elements during dictation.

Essential Elements for CPT 36590 Operative Notes

Pre-procedure evaluation details belong in the medical record. Document the patient’s current use of anticoagulation, platelet count, and INR values. Note any signs of port site infection, skin integrity issues, or palpable abnormalities over the device. Record informed consent discussions covering removal risks, including bleeding, infection, catheter fracture, and need for additional intervention if complications arise.

Intraoperative findings carry significant weight. Describe device appearance at removal, noting any catheter discoloration suggesting biofilm formation, evidence of thrombus adherent to the catheter surface, or tissue reaction around the port pocket. When cultures are obtained from the catheter tip or port septum, document the specimens sent and reference the laboratory orders. This microbiological data supports infection-related removal justifications and guides subsequent antibiotic therapy.

Closure technique documentation completes the procedural narrative. Specify suture material used, number of layers closed, and whether drains were placed. Note post-procedure dressing application and patient tolerance of the procedure. Include immediate complications observed and any intraoperative measures taken to address them. These details establish the procedure’s scope and complexity, supporting RVU assignments and differentiating the work from simpler catheter removals.

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Modifiers and Billing Scenarios for CPT 36590

Modifier application determines accurate reimbursement for complex removal scenarios. Modifier 22 (increased procedural services) applies when removal requires substantially greater work than typical cases. Examples include extensive scar tissue requiring prolonged dissection, catheter adherent to vessel walls necessitating careful mobilization, or simultaneous management of port site infection requiring debridement beyond simple device extraction. Documentation must quantify the additional time and complexity to support modifier 22 claims.

Modifier 25 becomes relevant when an evaluation and management (E/M) service occurs on the same day as port removal. If a patient presents for unrelated care and during the encounter the provider identifies an infected or malfunctioning port requiring immediate removal, both the E/M service and 36590 may be separately reportable. The E/M documentation must demonstrate a separately identifiable assessment beyond the procedure’s pre-operative evaluation. Surgical practice software with integrated E/M coding support helps practices identify these billing opportunities.

Modifier 76 (repeat procedure by same physician) codes situations where initial removal attempts prove incomplete, requiring a return to the operating room. This scenario arises when catheter fragments remain after the first procedure, necessitating additional intervention for complete extraction. Documentation must clearly establish that the repeat procedure addresses residual device components rather than complications from the initial removal, which would require different coding.

Place of Service Impact on CPT 36590 Coding

Facility versus non-facility designation affects both coding and reimbursement. Hospital outpatient departments bill the facility fee separately from professional services, using CPT 36590 with place of service 22. The hospital receives facility payment based on ambulatory payment classification (APC) assignments, while the performing physician bills professional services using the same CPT code with different RVUs. This split billing requires coordination between hospital coding staff and physician billing departments.

Office-based procedures carry higher practice expense RVUs reflecting equipment costs, supply expenses, and facility overhead absorbed by the performing practice. Ambulatory surgery centers occupy a middle ground, with facility fees lower than hospital outpatient departments but higher than physician office settings. Payer contracts may specify acceptable places of service for 36590, with some insurers requiring hospital-based removal for patients with specific comorbidities.

Observation status affects billing when removal occurs during a hospital stay. If the port removal represents the primary reason for the observation admission, 36590 becomes the principal procedure code. However, when removal occurs as a secondary service during observation for another condition, documentation must establish the removal’s clinical necessity independent of the primary admission diagnosis. The CMS HCPCS overview clarifies observation billing rules and their intersection with procedural coding.

Common CPT 36590 Claim Denials and Prevention Strategies

Medical necessity denials represent the most frequent rejection category for 36590 claims. Payers scrutinize removal timing, questioning whether extraction was clinically indicated or electively performed for patient convenience. Documentation must establish objective clinical findings supporting removal, such as positive blood cultures from the catheter, imaging evidence of catheter malposition, or laboratory confirmation of treatment completion eliminating ongoing device needs. Understanding central venous catheter complications helps providers document appropriate medical necessity justifications.

, imaging evidence of catheter malposition, or laboratory confirmation of treatment completion eliminating ongoing device needs.

Incorrect code selection generates denials when device type misidentification occurs. Submitting 36590 for a tunneled catheter without a port triggers automatic denials from payers using claims editing software that cross-references procedure codes against device descriptions in operative notes. Regular audits comparing coded procedures to actual devices removed help practices identify systematic coding errors before they escalate into pattern-based payer audits.

Bundling edits under the National Correct Coding Initiative (NCCI) prevent separate payment for services considered components of 36590. Providers should reference the National Correct Coding Initiative edits to verify which services bundle into the primary procedure code.

for services considered components of 36590. Imaging guidance used during removal, such as fluoroscopy to confirm complete catheter extraction, typically bundles into the primary procedure code. According to CMS list of CPT/HCPCS codes, some imaging procedures may be separately reportable with appropriate modifier 59 documentation, but most practices find fluoroscopy included in the 36590 allowance.

Pre-Authorization Requirements by Insurance Type

Medicare Advantage plans often impose stricter authorization requirements than traditional Medicare. These plans may require peer-to-peer discussions before approving port removals within six months of placement, viewing early removal as potentially avoidable. Clinical documentation supporting early removal must address specific complications or treatment changes that render the device unnecessary before its expected lifespan.

Commercial payers implement varied authorization protocols. Some insurers require only notification for 36590, while others demand full pre-authorization with clinical notes submitted before scheduling. Wellcare authorization lookup tools allow providers to verify requirements by entering the CPT code and patient insurance details. Practices should maintain a payer authorization matrix documenting each insurer’s specific requirements for port removal procedures.

Medicaid programs vary by state in their 36590 coverage policies. Some state Medicaid agencies classify port removal as automatically covered when medically necessary, while others require prior authorization for all tunneled catheter removals. Federal Medicaid billing guides provide baseline coverage criteria, but state-specific amendments introduce variations. Practices serving Medicaid populations must track authorization requirements across all states where they see patients.

CPT 36590 Compliance and Regulatory Considerations

False Claims Act compliance exposure arises when practices systematically upcode catheter removals. Billing 36590 for devices lacking subcutaneous ports constitutes fraudulent coding if done knowingly. Even unintentional pattern-based errors trigger liability when audits reveal consistent overcoding. The Office of Inspector General targets procedural coding accuracy in physician practice audits, making compliance programs essential for practices performing frequent catheter removals.

Stark Law considerations emerge when referring physicians maintain financial relationships with facilities performing port removals. Physician-owned ambulatory surgery centers must structure their removal services to comply with Stark exceptions, ensuring referrals follow permitted pathways. Designated health services rules specifically address surgical procedures, requiring practices to evaluate their 36590 referral patterns against regulatory safe harbors.

Anti-kickback statute scrutiny applies when removal services become part of broader device management programs. Bundled payment arrangements covering port placement, maintenance, and removal must be structured at fair market value to avoid prohibited remuneration allegations. Practices should document their fee schedule development process, comparing their 36590 charges to regional benchmarks and Medicare rates.

Quality Reporting and CPT 36590 Performance Measures

Quality reporting programs increasingly incorporate catheter removal complications. The Centers for Medicare & Medicaid Services tracks adverse events following vascular device procedures, including post-removal bleeding, infection, and retained device fragments. Practices participating in Merit-based Incentive Payment System (MIPS) may find their 36590 outcomes influencing quality scores and subsequent payment adjustments.

Patient safety organizations collect data on catheter removal complications, creating benchmarks for comparing individual practice performance to specialty norms. High complication rates following 36590 procedures trigger targeted peer review and potential remedial education requirements. Compliance management software helps practices track removal outcomes and identify concerning patterns before they reach regulatory attention.

Credentialing bodies scrutinize procedural outcomes during physician reappointment processes. Hospital medical staff offices review 36590 cases where complications occurred, evaluating documentation quality, informed consent adequacy, and technical performance. Privileges for port removal may face restriction if audit findings reveal consistent documentation deficiencies or adverse outcome patterns exceeding expected ranges.

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Conclusion

CPT code 36590 captures the technical complexity and clinical significance of removing tunneled central venous access devices with subcutaneous ports or pumps. Accurate coding requires precise device identification, comprehensive documentation of clinical necessity, and careful attention to anatomical detail. Reimbursement success depends on understanding RVU structure, modifier application, and payer-specific authorization requirements.

Practices performing port removals must implement systematic approaches to documentation, coding validation, and compliance monitoring. The distinction between 36590 and 36589 represents a frequent source of coding errors, making device component verification essential before claim submission. As payers increasingly scrutinize procedural coding through automated edits and post-payment audits, investment in coding education and technology-enabled validation becomes necessary for financial sustainability.

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