PayPredict Today: 2026 Medicare PFS · RVU26D
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Unilateral Wada Test

Billed together on one claim

36224 95812-26 95957 96116 96121 96136 96137 36226

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Price for scenario

San Jose Inpatient MD $706.13
Facility · Traditional Medicare 1 to resolve
San Jose Outpatient MD $5,563.28
Office · Traditional Medicare 1 to resolve
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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
$5,563.28
Total the claim is paid on
Medicare pays
$4,361.61
80%, less 2% sequestration
Patient owes
$1,112.66
20% coinsurance, once the Part B deductible is met
Billing rules changed it by
−$1,651.47
from $7,214.75 at full fee schedule

Before billing · 1 item to resolve

  • Bundled into 36224 95812-26

    NCCI denies 95812 billed with 36224. 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 $3,253.36
    Place cath carotd art
    Fee schedule $3,253.36
  2. 36226 $1,580.90
    Place cath vertebral art
    Fee schedule $3,161.80
    • Multiple procedureMultiple procedure (50%) −$1,580.90
  3. 95957 $421.72
    Eeg digital analysis
    Fee schedule $421.72
  4. 96116 $113.10
    Nubhvl xm phys/qhp 1st hr
    Fee schedule $113.10
  5. 96121 $89.54
    Nubhvl xm phy/qhp ea addl hr
    Fee schedule $89.54
  6. 95812-26 $0.00
    Eeg 41-60 minutes
    Bundled into 36224
    Fee schedule $70.57
    • NCCI bundlingBundled into 36224 (NCCI) −$70.57
  7. 96136 $56.30
    Psycl/nrpsyc tst phy/qhp 1st
    Fee schedule $56.30
  8. 96137 $48.36
    Psycl/nrpsyc tst phy/qhp ea
    Fee schedule $48.36
  9. Total allowed $5,563.28
    $7,214.75 fee schedule −$1,651.47 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 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
95957 1.93 × 1.11 7.24 × 1.442
non-facility
 0.11 × 0.397 12.6261 33.4009 $421.72 No global period No reduction No bilateral adjustment Needs documentation Not permitted
96116 1.86 × 1.11 0.9 × 1.442
non-facility
 0.06 × 0.397 3.3862 33.4009 $113.10 No global period No reduction No bilateral adjustment Needs documentation Not permitted
96121 1.71 × 1.11 0.54 × 1.442
non-facility
 0.01 × 0.397 2.6808 33.4009 $89.54 Add-on code No reduction No bilateral adjustment Needs documentation Not permitted
95812-26 1.08 × 1.11 0.62 × 1.442
non-facility
 0.05 × 0.397 2.1127 33.4009 $70.57 No global period No reduction No bilateral adjustment Needs documentation Not permitted
96136 0.55 × 1.11 0.74 × 1.442
non-facility
 0.02 × 0.397 1.6855 33.4009 $56.30 No global period No reduction No bilateral adjustment Needs documentation Not permitted
96137 0.46 × 1.11 0.65 × 1.442
non-facility
 0.0 × 0.397 1.4479 33.4009 $48.36 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.