Reimbursement
$3.00
Threshold
N/A
2026 Status
Active
What is CPT Code 36415?
CPT 36415 is defined as: The collection of venous blood through the insertion of a needle into a vein (venipuncture). This is a routine procedure used to obtain blood samples for laboratory analysis. It is generally reported once per patient encounter, regardless of the number of tubes drawn or the number of attempts required to achieve a successful draw.
This code is primarily used for Specialist services. It falls under the category of Pathology and Laboratory / Surgery and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0
Physician Effort
PE (Non-Fac)
0
Practice Expense
Malpractice
0
Risk Factor
Total RVU
0
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency adjustment
Subject to -2.5% Efficiency Adjustment. CMS has reduced the Work RVU component, citing productivity gains and standardized collection systems that have minimized staff effort per draw.
conversion factor
Payment based on the 2026 Non-QP baseline of $33.40.
pfs vs clfs
Note that some payers reimburse 36415 under the Clinical Laboratory Fee Schedule (CLFS) rather than the Physician Fee Schedule (PFS); check specific payer contracts for 2026 rates.
Administrative Framework
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
frequency limit
Reported only once per patient encounter, regardless of how many tubes are drawn or how many veins are punctured.
non billable scenarios
36415 cannot be billed if the blood is collected from an existing central venous catheter or PICC line (use 36591/36592 instead).
order linkage
The venipuncture must be linked to a specific, medically necessary laboratory test ordered by a physician or QHP.
facility billing
Independent laboratories (POS 81) often bill 36415 in conjunction with the diagnostic tests performed.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Work RVU reduced by 2.5% efficiency adjustment. National payment remains low (~$5.68).
Common Clinical Scenarios
No clinical examples provided.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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