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CPT 36415 Venipuncture Billing Guide

Updated Oct 30, 2026

CPT 36415 is the code for collecting a venous blood specimen by routine venipuncture, the needle draw that produces the tubes a lab tests. Medicare pays it as a specimen collection fee under the Clinical Laboratory Fee Schedule. For CY 2026, CMS states that the general specimen collection fee is $9.34 per patient encounter (Medicare Claims Processing Manual, Ch. 16 §60.1). The same amount appears for 36415 in the CY 2026 Q4 CLFS file.

2026 specimen collection codes and Medicare amounts

Code When it applies (paraphrased) CY 2026 Medicare amount Source
36415 Routine venous blood collection by venipuncture $9.34 CLFS 26CLABQ4; Pub. 100-04 Ch. 16 §60.1
G0471 Venipuncture or catheter urine collection for a patient in a skilled nursing facility (SNF), or by a lab on behalf of a home health agency (HHA) $11.34 CLFS 26CLABQ4; Pub. 100-04 Ch. 16 §60.1
P9612 / P9615 Catheterization to collect a specimen (single patient / multiple patients) $9.34 each CLFS 26CLABQ4; Pub. 100-04 Ch. 16 §60.1.2
36416 Capillary (finger or heel stick) collection Not listed in the CY 2026 Q4 CLFS file CLFS 26CLABQ4

CMS states that the collection fee is updated each year by the change in CPI-U for the 12 months ending June 30 of the prior year. The $2 add-on for SNF and HHA collections produces the G0471 amount (Ch. 16 §60.1).

The Medicare rules for 36415

Rule What CMS says (summarized)
Eligible specimen types A collection fee is allowed for venipuncture blood draws or urine collected by catheterization. Low-cost collections such as throat swabs or routine capillary punctures don't qualify.
One fee per encounter Only one collection fee is allowed per specimen type per patient encounter, regardless of how many tubes are drawn. A series of draws for one test (for example, a glucose tolerance test) counts as a single encounter.
Who may bill The fee isn't paid to anyone who did not actually extract the specimen.
No cost sharing The Part B deductible and 20% coinsurance do not apply to specimen collection fees.
Homebound / nursing home draws An independent lab can be paid for a trained technician's draw when it is medically necessary (for example, a homebound patient or a facility with no qualified staff on duty). The claim should be annotated accordingly.
Payment locality For independent labs, the fee is paid based on the location of the lab where the test is performed, and it is billed together with a covered lab test.

All rules: CMS Medicare Claims Processing Manual, Chapter 16, §60.1–60.1.2.

Common 36415 scenarios

Scenario Billing approach
Office draws three tubes, sends all out to a reference lab Office bills 36415 once (it drew the specimen). The reference lab bills the tests.
Patient sees two providers in one visit, one draw One 36415 for that encounter.
Glucose tolerance test with timed draws Treated as one encounter, so one collection fee.
Finger stick for a waived A1c 36415 doesn't apply. Bill the test (with QW if needed).
Mobile phlebotomist draws a homebound patient for an independent lab G0471 if the patient qualifies under the SNF or HHA criteria. Otherwise, 36415 with the homebound annotation. Confirm with your MAC.

Documentation that supports the claim

Keep the order, the draw date and time, who performed the draw, the collection site and specimen types, and, for homebound draws, the reason a technician was needed. Under CLIA, labs must also keep specimen identification and preanalytic records (42 CFR 493.1241–493.1242). myLabCompliance tracks phlebotomy staff training and competency, procedures, and preanalytic documentation alongside the rest of your CLIA program.

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FAQs

What is the 2026 Medicare rate for CPT 36415?

$9.34 per patient encounter, according to CMS Pub. 100-04 Ch. 16 §60.1 and the CY 2026 Q4 CLFS file.

Can I bill 36415 more than once per day?

Medicare allows one collection fee per specimen type per patient encounter. Separate, distinct encounters on the same day may each qualify, but you need documentation for each.

Is 36416 (capillary stick) payable by Medicare?

CMS says routine capillary punctures don't qualify for the collection fee, and 36416 does not appear in the CY 2026 Q4 CLFS file.

When do I use G0471 instead of 36415?

Use G0471 when the draw is from a patient in a SNF, or when a lab performs it on behalf of a home health agency. The 2026 amount is $11.34.

Does the patient owe coinsurance on 36415?

No. CMS states that the Part B deductible and coinsurance don't apply to specimen collection fees.

Can a reference lab bill 36415 for a specimen it received?

No. The fee is paid only to the entity that extracted the specimen.

Does 36415 need a modifier?

There's no QW for 36415. Other modifiers depend on payer rules, such as NCCI edits when it's billed with E/M or other procedures.

Sources