PayPredict Today: 2026 Medicare PFS · RVU26D
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Temp package (2026)

Billed together on one claim

76937-26 36222 ×2 36223 ×2 36226 61645

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Price for scenario

San Jose Inpatient MD $792.76
Facility · Traditional Medicare 3 to resolve
San Jose Outpatient MD $792.76
Office · Traditional Medicare 3 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
$792.76
Total the claim is paid on
Medicare pays
$621.53
80%, less 2% sequestration
Patient owes
$158.55
20% coinsurance, once the Part B deductible is met
Billing rules changed it by
−$1,476.45
from $2,269.21 at full fee schedule

Before billing · 3 items to resolve

  • Units over the daily MUE 36222

    Medicare denies every unit of 36222 when more than 1 are billed for one day. If it was done on both sides, bill one unit with modifier 50 (36222-50, paid at 150%). Otherwise bill at most 1 unit, or document why more were needed and appeal (clinical edit).

  • Units over the daily MUE 36223

    Medicare denies every unit of 36223 when more than 1 are billed for one day. If it was done on both sides, bill one unit with modifier 50 (36223-50, paid at 150%). Otherwise bill at most 1 unit, or document why more were needed and appeal (clinical edit).

  • Bundled into 61645 36226

    NCCI denies 36226 billed with 61645. 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. 61645 $777.28
    Perq art m-thrombect &/nfs
    Fee schedule $777.28
  2. 36226 $0.00
    Place cath vertebral art
    Bundled into 61645
    Fee schedule $340.35
    • NCCI bundlingBundled into 61645 (NCCI) −$340.35
  3. 36223 ×2 $0.00
    Place cath carotid/inom art
    Units over the daily MUE
    Fee schedule $306.76 × 2 = $613.52
    • Unit limitOver MUE of 1 per day −$613.52
  4. 36222 ×2 $0.00
    Place cath carotid/inom art
    Units over the daily MUE
    Fee schedule $261.29 × 2 = $522.58
    • Unit limitOver MUE of 1 per day −$522.58
  5. 76937-26 $15.48
    Us guide vascular access
    Fee schedule $15.48
  6. Total allowed $792.76
    $2,269.21 fee schedule −$1,476.45 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)
61645 14.63 × 1.11 3.69 × 1.442
facility
 4.31 × 0.397 23.2714 33.4009 $777.28 0-day global No reduction 150% with 50 Needs documentation 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
36223 5.61 × 1.11 1.58 × 1.442
facility
 1.71 × 0.397 9.1843 33.4009 $306.76 0-day global Standard (2nd+ at 50%) 150% with 50 Not paid Not permitted
36222 5.15 × 1.11 1.1 × 1.442
facility
 1.31 × 0.397 7.8228 33.4009 $261.29 0-day global Standard (2nd+ at 50%) 150% with 50 Not paid Not permitted
76937-26 0.29 × 1.11 0.09 × 1.442
facility
 0.03 × 0.397 0.4636 33.4009 $15.48 Add-on code 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.