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
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San Jose Inpatient 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
Facility rates · Physician
Payer
Traditional Medicare
Priced as of
November 13, 2026
Medicare allowed
$780.62
Total the claim is paid on
Medicare pays
$612.01
80%, less 2% sequestration
Patient owes
$156.12
20% coinsurance, once the Part B deductible is met
Billing rules changed it by
—
from $780.62 at full fee schedule

Nothing required before billing, but 75898 and 37227 pay $0. See the claim lines and payment risks.

Claim lines

Highest-paid first, the order Medicare ranks multiple procedures
  1. 61626 $780.62
    Tcat perm occls/embol noncns
    Fee schedule $780.62
  2. 75898 ×3 —
    Follow-up angiography
    Not separately paid by Medicare
    Not paid
  3. 37227 —
    —
    Not in the fee schedule
    Not found
  4. Total allowed $780.62
    $780.62 fee schedule — billing rules

Payment risks · 2

  • Not separately paid by Medicare 75898

    75898: No facility rate: in a facility setting bill the professional component (-26).

  • 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 3.6 × 1.442
facility
 4.05 × 0.397 23.3714 33.4009 $780.62 0-day global Standard (2nd+ at 50%) No bilateral adjustment Not paid Not permitted
75898 1.8 × 1.11 5.94 × 1.442
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.