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 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
$706.13
Total the claim is paid on
Medicare pays
$553.60
80%, less 2% sequestration
Patient owes
$141.23
20% coinsurance, once the Part B deductible is met
Billing rules changed it by
−$240.75
from $946.88 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 $342.81
    Place cath carotd art
    Fee schedule $342.81
  2. 36226 $170.17
    Place cath vertebral art
    Fee schedule $340.35
    • Multiple procedureMultiple procedure (50%) −$170.18
  3. 96116 $81.31
    Nubhvl xm phys/qhp 1st hr
    Fee schedule $81.31
  4. 95812-26 $0.00
    Eeg 41-60 minutes
    Bundled into 36224
    Fee schedule $70.57
    • NCCI bundlingBundled into 36224 (NCCI) −$70.57
  5. 96121 $69.31
    Nubhvl xm phy/qhp ea addl hr
    Fee schedule $69.31
  6. 96136 $24.03
    Psycl/nrpsyc tst phy/qhp 1st
    Fee schedule $24.03
  7. 96137 $18.50
    Psycl/nrpsyc tst phy/qhp ea
    Fee schedule $18.50
  8. 95957 —
    Eeg digital analysis
    Not separately paid by Medicare
    Not paid
  9. Total allowed $706.13
    $946.88 fee schedule −$240.75 billing rules

Payment risks · 1

  • Not separately paid by Medicare 95957

    95957: No facility rate: in a facility setting bill the professional component (-26).

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
96116 1.86 × 1.11 0.24 × 1.442
facility
 0.06 × 0.397 2.4345 33.4009 $81.31 No global period No reduction No bilateral adjustment Needs documentation Not permitted
95812-26 1.08 × 1.11 0.62 × 1.442
facility
 0.05 × 0.397 2.1127 33.4009 $70.57 No global period No reduction No bilateral adjustment Needs documentation Not permitted
96121 1.71 × 1.11 0.12 × 1.442
facility
 0.01 × 0.397 2.0751 33.4009 $69.31 Add-on code No reduction No bilateral adjustment Needs documentation Not permitted
96136 0.55 × 1.11 0.07 × 1.442
facility
 0.02 × 0.397 0.7194 33.4009 $24.03 No global period No reduction No bilateral adjustment Needs documentation Not permitted
96137 0.46 × 1.11 0.03 × 1.442
facility
 0.0 × 0.397 0.5539 33.4009 $18.50 Add-on code No reduction No bilateral adjustment Needs documentation Not permitted
95957 1.93 × 1.11 7.24 × 1.442
facility
 0.11 × 0.397 12.6261 33.4009 $421.72 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.