PayPredict Today: 2026 Medicare PFS · RVU26D
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Bilateral Wada Test

Billed together on one claim

36224 ×2 95812-26 ×2 95957-26 ×2 96116 96121 96136 96137 36226 ×2

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Price for scenario

San Jose Inpatient MD $193.15
Facility · Traditional Medicare 4 to resolve
San Jose Outpatient MD $307.30
Office · Traditional Medicare 4 to resolve
+ Scenario

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
$307.30
Total the claim is paid on
Medicare pays
$240.92
80%, less 2% sequestration
Patient owes
$61.46
20% coinsurance, once the Part B deductible is met
Billing rules changed it by
−$13,216.60
from $13,523.90 at full fee schedule

Before billing · 4 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 95812-26

    Medicare denies every unit of 95812 when more than 1 are billed for one day. Bill at most 1 unit, or document why more were needed and appeal (clinical edit).

  • Units over the daily MUE 95957-26

    Medicare denies every unit of 95957 when more than 1 are billed for one day. 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 $3,253.36 × 2 = $6,506.72
    • Unit limitOver MUE of 1 per day −$6,506.72
  2. 36226 ×2 $0.00
    Place cath vertebral art
    Units over the daily MUE
    Fee schedule $3,161.80 × 2 = $6,323.60
    • Unit limitOver MUE of 1 per day −$6,323.60
  3. 95957-26 ×2 $0.00
    Eeg digital analysis
    Units over the daily MUE
    Fee schedule $122.57 × 2 = $245.14
    • Unit limitOver MUE of 1 per day −$245.14
  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 ×2 $0.00
    Eeg 41-60 minutes
    Units over the daily MUE
    Fee schedule $70.57 × 2 = $141.14
    • Unit limitOver MUE of 1 per day −$141.14
  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 $307.30
    $13,523.90 fee schedule −$13,216.60 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
95957-26 1.93 × 1.11 1.04 × 1.442
non-facility
 0.07 × 0.397 3.6698 33.4009 $122.57 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.