CPT code 36589: Removal of tunneled CVAD without port or pump

CPT code 36589 is the procedure code for removal of a tunneled central venous catheter without a subcutaneous port or pump. It covers Hickman, Broviac and Groshong lines, plus tunneled dialysis catheters, when the whole catheter comes out and no implanted reservoir comes out with it.

When a port or pump is removed along with the catheter, the claim goes out as CPT 36590 instead. Both descriptors hinge on that one reservoir, so the procedure note has to say which device was removed. This reference covers the documentation, ICD-10 pairings, Medicare payment, modifiers and denial patterns for 36589.

Key takeaways

CPT 36589 covers tunneled catheter removal only when no subcutaneous port or pump is present. Port or pump removal uses CPT 36590.

Hickman, Broviac and Groshong catheters are the devices most often billed under 36589, and the operative note must confirm the device type.

Missing documentation of tunneled construction, and of the absence of a subcutaneous reservoir, are the top two reasons 36589 claims are denied.

Medicare pays 36589 under a 10-day global period, at about $166 in an office and $125 in a facility before geographic adjustment.

Pabau’s claims management software tracks vascular access claim status and flags incomplete documentation before the claim is submitted.

CPT code 36589: Official descriptor and procedure scope

The American Medical Association’s CPT code set gives the official descriptor for 36589 as Removal of tunneled central venous catheter, without subcutaneous port or pump. The code sits in the Surgery section under Cardiovascular Procedures, in the Central Venous Access Procedures subsection (36555-36598).

The key clinical concept is tunneling. A tunneled catheter passes under the skin from the venous entry point to an exit site on the chest or upper arm. That tunnel lowers infection risk compared with non-tunneled lines, and it is what earns the device its own removal code.

Two device features determine which removal code applies:

• Tunneled construction: The catheter runs through a subcutaneous tunnel. Non-tunneled catheter removal is not separately reportable and is considered bundled into the associated procedure.
• No subcutaneous port or pump: If a reservoir (port-a-cath, mediport, implanted pump) is attached, use CPT 36590 instead.

Add a third check for complete removal, and the coding choice becomes the three-question path below. Each answer rules out one of the alternatives.

What the tunneled catheter removal procedure involves

Tunneled catheter removal happens at the bedside, in an outpatient office, or in an interventional suite. The setting depends on the patient’s condition and on whether the catheter is patent or adherent. The physician or qualified non-physician practitioner frees the Dacron cuff from the fibrous ingrowth around it, then applies steady traction until the line comes out.

For coding, the procedure note must document:

• Complete removal of the catheter body, not just the external portion
• Confirmation that no port or pump reservoir was present
• The device type, and the brand where available

Incomplete removal that needs a return procedure changes the coding scenario entirely.

Place of service also affects reimbursement. Removal in a physician office (POS 11) is paid at the non-facility rate. Removal in a hospital outpatient department or ambulatory surgical center is paid at the lower facility rate. There, the facility bills separately for overhead and supplies.

CPT 36589 vs. 36590: The most common coding error

The 36589 versus 36590 distinction is the rule coders misapply most often in tunneled catheter billing. The difference is one device component: a subcutaneous port or pump.

A removal that included a port should have been billed as CPT 36590. Billed as 36589 instead, the claim will be denied or, if paid, flagged in a retrospective audit. Coders should confirm the device type in the operative note, not from the ordering physician’s verbal description or the patient’s self-report.

CPT 36589 vs. PICC line removal

PICC line removal is not automatically coded with CPT 36589. The device’s construction decides the code. Most peripherally inserted central catheters are non-tunneled, so their removal is bundled and not separately reportable.

The access site, arm or chest, has no bearing on code selection. A tunneled catheter inserted through the arm follows the same 36589 logic as a Hickman line at a chest exit site. In both cases, no port can be present.

Common tunneled catheter types billed under 36589

These tunneled catheters are commonly billed under 36589 when they are removed without a subcutaneous port or pump:

• Hickman catheter: A single- or multi-lumen tunneled catheter, most often used for chemotherapy or long-term IV therapy. It is the device most frequently billed under 36589.
• Broviac catheter: A smaller-bore variant of the Hickman, commonly used in pediatric patients.
• Groshong catheter: Has a three-position valve tip that reduces the need for clamping. It is still tunneled, so it still qualifies for 36589 at removal.
• Tunneled hemodialysis catheters: Long-term tunneled lines placed for renal replacement therapy. Confirm no port is attached before applying 36589.

A brand name alone is not enough documentation. The operative or procedure note must confirm the tunneled construction, the cuff location and the exit site. Payer auditors routinely request the procedure note when a 36589 claim is queried.

Documentation requirements for a 36589 claim

A clean claim for CPT 36589 depends on specific elements in the procedure note. Payers and Medicare contractors look for all of the following:

• Device type and brand: Confirm the catheter is a tunneled central venous catheter, such as a Hickman or Groshong. A generic reference to a “central line” that doesn’t specify tunneled construction is inadequate.
• Absence of subcutaneous port or pump: The note must state explicitly that no port or pump was removed. If the note is silent on this point, payers may assume a port was present and apply 36590 or deny the claim.
• Confirmation of complete removal: Document that the entire catheter, including the cuff, was removed. Partial removal changes the coding scenario.
• Provider credentials: The performing provider must be credentialed for vascular access procedures under the payer’s participation agreement.
• Place of service: The POS code must match the care setting (office, outpatient hospital or ASC). A mismatch between the POS code and the billed facility fee triggers automatic edits.
• Indication for removal: Link the removal to an ICD-10 diagnosis (see the next section). Common reasons include completed therapy, infection, malfunction, or a device-related complication.

ICD-10-CM diagnosis codes paired with tunneled catheter removal

Every 36589 claim needs a supporting ICD-10-CM diagnosis code, which establishes medical necessity for the removal. The right pairing depends on the clinical reason for removal:

Z45.2 is the most commonly used diagnosis for routine elective removal at the end of a chemotherapy or antibiotic course. For complication-driven removal, the complication code takes precedence and is listed as the principal diagnosis, with any underlying condition sequenced behind it.

Medicare and payer coverage for CPT 36589

Medicare Part B covers CPT 36589 when a physician or qualified non-physician practitioner performs the removal and documentation supports medical necessity. The code carries a 10-day global surgical period (010) under the Medicare Physician Fee Schedule (MPFS). Related follow-up visits in the 10 days after removal are included in its payment.

Payment varies by place of service. The CMS Physician Fee Schedule lookup tool gives the current facility and non-facility rates by HCPCS/CPT code and locality. As a general benchmark (verify current rates using the CMS tool before billing):

• Non-facility rate (office setting): About $166 nationally, from 4.98 RVUs at the 2026 conversion factor of $33.4009, before geographic adjustment (GPCI).
• Facility rate (hospital outpatient or ASC): About $125 nationally, from 3.75 RVUs, before geographic adjustment. The facility bills separately for the technical component.

Rates change annually with each MPFS update. Verify current-year payment through the FastRVU RVU lookup tool or CMS directly before quoting expected reimbursement.

Prior authorization requirements by payer

Prior authorization requirements for CPT 36589 vary by payer and plan year. Traditional fee-for-service Medicare generally doesn’t require prior authorization for this code. Commercial payers and Medicare Advantage plans differ widely. Some require authorization for outpatient facility settings but not for office-based removal, while others apply clinical criteria based on the underlying diagnosis.

Check the payer’s authorization lookup portal before scheduling removal in a facility setting. A missing authorization results in a technical denial that is difficult to overturn on appeal.

Top reasons CPT 36589 claims are denied

Denial patterns for 36589 are predictable and largely preventable. Effective denial management workflows for vascular access claims focus on these recurring failure points:

• Wrong code selected (36590 instead of 36589): The most common error. A coder reads “port removal” in the scheduling note and selects 36590 without checking the device details in the operative note. Verify the complete device description before coding.
• Incomplete documentation of tunneled construction: A note documenting “central line removal” without specifying tunneled or non-tunneled fails to justify 36589. Payers treat non-tunneled removal as non-billable, so a note that doesn’t specify construction leads to denial or downcoding.
• Port/pump status not documented: If the note doesn’t state that no port or pump was removed, some payers apply 36590 automatically. The claim is then rejected on code mismatch, or the 36589 claim is denied for lack of supporting detail.
• Global period conflict: The catheter may have been placed during a procedure with an active global period (10-day global). If the placing surgeon also bills the removal, payers may deny 36589 as included in the global. Depending on the scenario, the claim may need -79 (unrelated procedure during the postoperative period) or -78 (unplanned return to the operating or procedure room).
• Incorrect place of service: A POS 22 (outpatient hospital) claim for a removal performed in a physician office triggers an automatic edit. Confirm the POS against the care setting on the date of service.
• Missing or invalid ICD-10 pairing: A 36589 claim without a valid supporting diagnosis will fail medical necessity screening at many payers. Typical pairings include Z45.2, T80.211A and T80.219A.

A denied 36589 claim comes back with a reason code that tells your billing team what went wrong. Our guide to denial codes for billers explains what the most common codes mean.

Modifiers used with CPT 36589

Several modifiers apply to CPT 36589, depending on the clinical scenario. The correct modifier prevents NCCI bundling edits and global period conflicts:

Billing compliance and audit considerations for 36589

The Office of Inspector General (OIG) and Recovery Audit Contractors (RACs) periodically target vascular access codes as part of broader cardiovascular billing reviews. With 36589 and 36590, the risk is upcoding.

That covers billing 36590, the higher-paying code, when documentation only supports 36589. It also covers billing 36589 for a non-tunneled removal that should not have been billed at all. Consistent medical billing compliance practices protect against both.

Specific audit red flags for vascular access removal codes include:

• A high ratio of 36590 claims relative to 36589 claims (statistically inconsistent with most practice device mixes)
• Repeated same-day billing of catheter removal alongside catheter placement without documented clinical rationale
• Missing or generic operative notes that do not specify device type
• Claims submitted with POS codes that do not match facility billing records

Keep the original procedure notes for vascular access removals for at least seven years. Medicare contractors may request records from any claim period within their lookback window. Claims software for billers that links each claim to its documentation reduces audit exposure, because the supporting record is immediately retrievable.

How claims management software keeps 36589 claims clean

In a generic billing tool, a missing port statement often surfaces only when the remittance comes back. By then the claim needs a correction, a resubmission and another wait for payment.

Pabau, the practice management platform we build, turns the invoice for the removal into an electronic CMS-1500 claim. Its claim validation checks each claim for missing or invalid details before it leaves the practice. In the US, claims reach payers through Claim.MD, Pabau’s clearinghouse partner.

Claim statuses and electronic remittance advice come back into Pabau, so your team can see where each removal claim stands.

A claim that comes back rejected is flagged Needs action, with a link straight to the field that needs correcting. That helps catch incomplete documentation before the claim is submitted again. It also keeps the procedure note one step from the claim if an auditor asks for it.

Simplify vascular access claim tracking

Pabau’s claim validation checks each vascular access claim for missing or invalid details before submission. You then track its status through to payment in one workflow.

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Conclusion

The device decides the code on every tunneled catheter removal. Before a 36589 claim leaves the practice, the operative note should confirm three facts: tunneled construction, no port or pump, and complete removal.

Pair those facts with the diagnosis that matches the reason for removal, and the common denial triggers for this code fall away. The cost is a few extra minutes at the documentation stage. That is far cheaper than an appeal, or an audit finding a year later.

For practices billing vascular access removals at volume, Pabau’s revenue cycle management workflow tracks claim status from submission through adjudication. It also helps catch incomplete documentation before the claim is submitted. Book a demo to see how Pabau takes a removal claim from procedure note to payment.

Continue your research

Need to understand clean claim requirements for procedural codes? Clean claim submission covers the documentation and formatting standards that reduce first-pass denial rates across procedure code families.

Managing vascular access denials at scale? Denial management in healthcare explains how to build a systematic denial tracking and appeal workflow for high-volume practices.

Want to understand how clearinghouse submission works? Medical claims clearinghouse explains how 837P electronic claims are validated, submitted, and acknowledged before reaching the payer.

Coding the placement instead? CPT 36558 covers insertion of a tunneled central venous catheter without a port or pump, for patients aged 5 and older.

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