CPT 36415: routine venipuncture
36415 reports a venous blood draw by venipuncture, and Medicare prices it on the clinical laboratory fee schedule, not the physician fee schedule. It carries status X in the fee schedule file, one unit covers all tubes of one specimen type in an encounter, and no deductible or coinsurance applies.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 36415 is the venous blood draw code, priced on the clinical laboratory fee schedule and billed once per specimen type per encounter. The manual limits the collection fee to a trained technician drawing from a homebound patient or non-hospital inpatient. Neither the deductible nor the 20 percent coinsurance applies.
What does CPT 36415 report?
36415 reports collecting a venous blood sample by venipuncture. It is not a physician fee schedule service: the October 2026 fee schedule file (RVU26D) gives it status X, a statutory exclusion, with no RVUs, and CMS prices it on the clinical laboratory fee schedule.
CMS confirms this in its CY 2026 CLFS annual update, which says the CLFS includes separately payable fees for specimen collection codes 36415, P9612, P9615 and G0471. A different code, 36410, is a venipuncture that the fee schedule file marks active (status A) and labels as needing a physician or qualified professional; NCCI Chapter XI treats it as part of IV injections of dye.
| Item | Value |
|---|---|
| Payment status | X (statutory exclusion; no RVUs shown) |
| PC/TC indicator | 9 (concept does not apply) |
| Global period | XXX |
| Where it is priced | Clinical laboratory fee schedule |
| Practitioner MUE, Q4 2026 | 2 per date, indicator 3, rationale CMS policy |
When is venipuncture separately payable?
Chapter 16, section 60.1 of the Claims Processing Manual sets the test for the specimen collection fee. The sample must support a clinical diagnostic lab test paid on the CLFS, be collected by a trained technician from a homebound patient or a non-hospital inpatient when no qualified personnel are available at the facility, and be venous blood by venipuncture or urine by catheterization.
A draw that does not fit that description, such as one in your own office, falls to your MAC and the payer's policy, so confirm before relying on 36415 for payment.
Section 60.1.2 requires 36415 as the code for a venous draw and says neither the annual deductible nor the 20 percent coinsurance applies. For a patient in a skilled nursing facility, or a lab drawing for a home health agency, the manual names G0471 instead.
How many units of 36415 can you bill?
One. Section 60.1 allows one collection fee for each type of specimen per patient encounter, however many tubes are drawn, and treats a series of draws for one test, such as a glucose tolerance test, as a single encounter.
A routine capillary puncture, such as for clotting or bleeding time, is named as not payable under the fee. The practitioner MUE of 2 per date is a ceiling, not a target.
For 2026, section 60.1 states the general fee at $9.34 for all specimens collected in one encounter, and $11.34 for a Medicare patient in a SNF or on behalf of a home health agency.
How do you bill a CBC with differential and the draw?
Each test is its own line and the draw is one more line. The fee schedule file labels 85025 as a complete CBC with automated differential and gives it status X too, so the test is also paid on the CLFS.
A patient has a CBC with differential and a basic metabolic panel from one blood draw. The claim carries the CBC, the panel and 36415 with 1 unit, not one unit per tube.
Lab claims must carry the 10-digit CLIA number of the lab that performed the test: in item 23 of the CMS-1500 or in REF02 with qualifier X4 on the 837P (chapter 16, section 70.10; chapter 26, item 23). The same lab-side rules appear in CPT 83036.
What changes for hospitals and dialysis patients?
In the hospital outpatient setting, chapter 4 assigns status indicator Q4 to laboratory HCPCS codes on the CLFS. A Q4 service is packaged when billed with a J1, J2, S, T, V, Q1, Q2 or Q3 service and is otherwise paid at the CLFS rate.
For dialysis, section 60.1.3 says the collection fee is not separately payable for patients dialyzed in the facility or at home under Method I, or when an ESRD facility collects for transplant requirements, because the ESRD PPS includes it. Draws in the hospital outside the dialysis unit, for tests outside the composite rate, may be paid separately.
Where does 36415 go on a professional or hospital claim?
A venipuncture charge is a small line that carries a lot of rejections. On the CMS-1500 it goes in Item 24D with units in Item 24G for the draws actually made. Item 24E points to the diagnosis tied to the test being ordered, not to a vague routine code, so the payer can see the lab and the draw belong together.
RVU26D marks 36415 as status X and the MUE table limits it to 2 units per date with the rationale CMS Policy. RVU26D defines status X as a statutory exclusion with no RVUs and no payment under the physician fee schedule, so payment for the draw depends on the lab payment rules and on the payer's contract.
On a hospital outpatient bill, the lab revenue code goes in FL 42, 36415 in FL 44, the draw date in FL 45 and units in FL 46. Chapter 25 asks for one line date for each revenue and procedure code, so draws on separate days cannot be rolled into one line.
Example: A patient has two draws on 10/18, one at the morning visit and one after an abnormal result at 3:30 pm. Item 24G shows 2 units on the 36415 line at $9.00 each. If the chart records only one stick, the second unit has no support and the line drops to 1.
Why does a 36415 claim deny?
| CARC | What X12 says | What usually causes it |
|---|---|---|
| 97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated | Draw bundled into a visit or procedure |
| 234 | This procedure is not paid separately | Payer policy treats the draw as part of the test |
| 16 | Claim/service lacks information or has submission/billing error(s) | No CLIA number; Medicare pairs this with RARC MA120 |
| 18 | Exact duplicate claim/service (use only with group code OA except where state workers' compensation regulations require CO) | Second 36415 line on one encounter |
If these denials keep coming back, our denial management team can work them. See also laboratory billing.
Related codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- Medicare Claims Processing Manual, Chapter 16: Laboratory Services · CMS
- Clinical Laboratory Fee Schedule, CY 2026 annual update (MM14312) · CMS
- Medicare Claims Processing Manual, Chapter 4: Part B Hospital (Including Inpatient Hospital Part B and OPPS) · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- 2026 NCCI Medicare Policy Manual, Chapter XI: Medicine and Evaluation and Management Services · CMS
- Claim Adjustment Reason Codes · X12
- Medicare Claims Processing Manual, Chapter 25: Completing and Processing the Form CMS-1450 Data Set · CMS
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Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01When is venipuncture 36415 separately payable?
Chapter 16, section 60.1 limits the collection fee to a venous draw by a trained technician from a homebound patient or non-hospital inpatient with no qualified personnel at the facility, for a test paid on the CLFS. Draws outside that description depend on your MAC and payer policy.
02How do I bill a CBC with differential?
Bill the CBC on its own line and add one unit of 36415 for the draw. Both codes carry status X in the fee schedule file, so both are paid on the lab fee schedule. The claim needs the performing lab's CLIA number in item 23 of the CMS-1500.
03Can 36415 be billed more than once on a visit?
Not for the same specimen type. Section 60.1 allows one collection fee for each type of specimen per encounter, however many tubes are drawn. A series of draws for one test counts as a single encounter, and the MUE is 2 per date.
04Do patients owe a copay or deductible for the draw?
Not for the specimen collection fee under Medicare. Section 60.1.2 says neither the annual deductible nor the 20 percent coinsurance applies to it. A patient on a commercial plan follows that plan's own cost-sharing rules, which can differ, so check the benefit.
05What code is used for a draw in a nursing home?
Chapter 16 names G0471 for a venous draw or catheterized urine sample from a patient in a skilled nursing facility, or by a lab on behalf of a home health agency. The 2026 fee is $11.34 per encounter, against $9.34 for the general fee.
Lab draws denied as not separately paid?
We check specimen collection lines against the payer's lab policy before claims go out.