PayPredict Today: 2026 Medicare PFS · RVU26D
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Unilateral ECA Embo

Billed together on one claim

61626 75898 ×3 37227

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Price for scenario

San Jose Inpatient MD $780.62
Facility · Traditional Medicare
San Jose Outpatient MD $13,730.99
Office · Traditional Medicare 1 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
$13,730.99
Total the claim is paid on
Medicare pays
$10,765.09
80%, less 2% sequestration
Patient owes
$2,746.20
20% coinsurance, once the Part B deductible is met
Billing rules changed it by
−$1,075.59
from $14,806.58 at full fee schedule

Before billing · 1 item to resolve

  • Units over the daily MUE 75898

    Medicare denies every unit of 75898 when more than 2 are billed for one day. Bill at most 2 units, or document why more were needed and appeal (clinical edit).

Claim lines

Highest-paid first, the order Medicare ranks multiple procedures
  1. 61626 $13,730.99
    Tcat perm occls/embol noncns
    Fee schedule $13,730.99
  2. 75898 ×3 $0.00
    Follow-up angiography
    Units over the daily MUE
    Fee schedule $358.53 × 3 = $1,075.59
    • Unit limitOver MUE of 2 per day −$1,075.59
  3. 37227 —
    —
    Not in the fee schedule
    Not found
  4. Total allowed $13,730.99
    $14,806.58 fee schedule −$1,075.59 billing rules

Payment risks · 1

  • Not in the fee schedule 37227

    37227 isn't in RVU26D. Check the code, or price it manually if it's paid outside the PFS (drugs, DME, labs).

Notes · 1

  • Before the Part B deductible

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

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)
61626 14.93 × 1.11 272.48 × 1.442
non-facility
 4.05 × 0.397 411.0963 33.4009 $13,730.99 0-day global Standard (2nd+ at 50%) No bilateral adjustment Not paid Not permitted
75898 1.8 × 1.11 5.94 × 1.442
non-facility
 0.43 × 0.397 10.7342 33.4009 $358.53 No global period No reduction No bilateral adjustment Needs documentation Not permitted

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.