PayPredict Today: 2026 Medicare PFS · RVU26D
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Venous sinus stenosis diagnostic

Billed together on one claim

36224 ×2 36226 ×2 93770 36012 ×2 75860-26 36011 ×2 36013 75870-26

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Price for scenario

San Jose Inpatient MD $373.35
Facility · Traditional Medicare 4 to resolve
San Jose Outpatient MD $2,267.41
Office · Traditional Medicare 4 to resolve
+ Scenario

San Jose Outpatient MD

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Fee schedule
2026 Medicare PFS · RVU26D
Effective October 1, 2026 · CF $33.4009
Locality
San Jose Sunnyvale Santa Clara (Santa Clara Cnty), CA (01112-09)
Setting · provider
Office (non-facility) rates · Physician
Payer
Traditional Medicare
Priced as of
November 13, 2026
Medicare allowed
$2,267.41
Total the claim is paid on
Medicare pays
$1,777.65
80%, less 2% sequestration
Patient owes
$453.48
20% coinsurance, once the Part B deductible is met
Billing rules changed it by
−$16,132.05
from $18,399.46 at full fee schedule

Before billing · 4 items to resolve

  • Units over the daily MUE 36224

    Medicare denies every unit of 36224 when more than 1 are billed for one day. If it was done on both sides, bill one unit with modifier 50 (36224-50, paid at 150%). Otherwise bill at most 1 unit, or document why more were needed and appeal (clinical edit).

  • Units over the daily MUE 36226

    Medicare denies every unit of 36226 when more than 1 are billed for one day. If it was done on both sides, bill one unit with modifier 50 (36226-50, paid at 150%). Otherwise bill at most 1 unit, or document why more were needed and appeal (clinical edit).

  • Bundled into 75870 75860-26

    NCCI denies 75860 billed with 75870. If it was a distinct service (different site, session or encounter), document that and add 59 or XE/XS/XP/XU.

  • Bundled into 36012 36011

    NCCI denies 36011 billed with 36012. If it was a distinct service (different site, session or encounter), document that and add 59 or XE/XS/XP/XU.

Claim lines

Highest-paid first, the order Medicare ranks multiple procedures
  1. 36224 ×2 $0.00
    Place cath carotd art
    Units over the daily MUE
    Fee schedule $3,253.36 × 2 = $6,506.72
    • Unit limitOver MUE of 1 per day −$6,506.72
  2. 36226 ×2 $0.00
    Place cath vertebral art
    Units over the daily MUE
    Fee schedule $3,161.80 × 2 = $6,323.60
    • Unit limitOver MUE of 1 per day −$6,323.60
  3. 36012 ×2 $1,659.01
    Place catheter in vein
    Fee schedule $1,106.01 × 2 = $2,212.02
    • Multiple procedureMultiple procedure (50%) −$553.01
  4. 36013 $538.32
    Place catheter in artery
    Fee schedule $1,076.65
    • Multiple procedureMultiple procedure (50%) −$538.33
  5. 36011 ×2 $0.00
    Place catheter in vein
    Bundled into 36012
    Fee schedule $1,074.74 × 2 = $2,149.48
    • NCCI bundlingBundled into 36012 (NCCI) −$2,149.48
  6. 75870-26 $70.08
    Vein x-ray skull
    Fee schedule $70.08
  7. 75860-26 $0.00
    Vein x-ray neck
    Bundled into 75870
    Fee schedule $60.91
    • NCCI bundlingBundled into 75870 (NCCI) −$60.91
  8. 93770 —
    Determination venous press
    Not separately paid by Medicare
    Not paid
  9. Total allowed $2,267.41
    $18,399.46 fee schedule −$16,132.05 billing rules

Payment risks · 1

  • Not separately paid by Medicare 93770

    93770: Bundled — payment is included in another service; never paid separately

Notes · 3

  • Before the Part B deductible

    Until the patient meets the annual Part B deductible, they pay the full allowed amount instead of 20% coinsurance.

  • Bill bilateral with modifier 50 36012

    Medicare pays a bilateral 36012 at 150% when billed as one unit with modifier 50, not as 2 units.

  • Bill bilateral with modifier 50 36011

    Medicare pays a bilateral 36011 at 150% when billed as one unit with modifier 50, not as 2 units.

How each fee is calculated (Work RVU × GPCI + PE RVU × GPCI + MP RVU × GPCI) × conversion factor ▸
Code Work Practice expense Malpractice Adjusted RVU × CF Fee Global Multiple procedure Bilateral (50) Assistant Co-surgeon (62)
36224 6.09 × 1.11 62.32 × 1.442
non-facility
 1.96 × 0.397 97.4035 33.4009 $3,253.36 0-day global Standard (2nd+ at 50%) 150% with 50 Not paid Not permitted
36226 6.09 × 1.11 60.43 × 1.442
non-facility
 1.92 × 0.397 94.6622 33.4009 $3,161.80 0-day global Standard (2nd+ at 50%) 150% with 50 Not paid Not permitted
36012 3.42 × 1.11 20.16 × 1.442
non-facility
 0.62 × 0.397 33.1131 33.4009 $1,106.01 No global period Standard (2nd+ at 50%) 150% with 50 Not paid Not permitted
36013 2.46 × 1.11 20.35 × 1.442
non-facility
 0.4 × 0.397 32.2341 33.4009 $1,076.65 No global period Standard (2nd+ at 50%) No bilateral adjustment Not paid Not permitted
36011 3.06 × 1.11 19.81 × 1.442
non-facility
 0.54 × 0.397 32.1770 33.4009 $1,074.74 No global period Standard (2nd+ at 50%) 150% with 50 Not paid Not permitted
75870-26 1.11 × 1.11 0.54 × 1.442
non-facility
 0.22 × 0.397 2.0981 33.4009 $70.08 No global period Cardiovascular (TC 25%) No bilateral adjustment Needs documentation Not permitted
75860-26 1.11 × 1.11 0.38 × 1.442
non-facility
 0.11 × 0.397 1.8237 33.4009 $60.91 No global period Cardiovascular (TC 25%) No bilateral adjustment Needs documentation Not permitted
93770 Status B: Bundled — payment is included in another service; never paid separately

GPCIs for San Jose Sunnyvale Santa Clara (Santa Clara Cnty), CA (01112-09) in RVU26D. Imaging fees are capped at the OPPS amount when that's lower.