PayPredict Today: 2026 Medicare PFS · RVU26D
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Foundational NIR (Dx Angio)

Billed together on one claim

36224 ×2 36226 ×2

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Price for scenario

San Jose Inpatient MD $0.00
Facility · Traditional Medicare 2 to resolve
San Jose Outpatient MD $0.00
Office · Traditional Medicare 2 to resolve
+ Scenario

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
$0.00
Total the claim is paid on
Medicare pays
$0.00
80%, less 2% sequestration
Patient owes
$0.00
20% coinsurance, once the Part B deductible is met
Billing rules changed it by
−$1,366.32
from $1,366.32 at full fee schedule

Before billing · 2 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).

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 $342.81 × 2 = $685.62
    • Unit limitOver MUE of 1 per day −$685.62
  2. 36226 ×2 $0.00
    Place cath vertebral art
    Units over the daily MUE
    Fee schedule $340.35 × 2 = $680.70
    • Unit limitOver MUE of 1 per day −$680.70
  3. Total allowed $0.00
    $1,366.32 fee schedule −$1,366.32 billing rules

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)
36224 6.09 × 1.11 1.89 × 1.442
facility
 1.96 × 0.397 10.2634 33.4009 $342.81 0-day global Standard (2nd+ at 50%) 150% with 50 Not paid Not permitted
36226 6.09 × 1.11 1.85 × 1.442
facility
 1.92 × 0.397 10.1898 33.4009 $340.35 0-day global Standard (2nd+ at 50%) 150% with 50 Not paid 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.