PayPredict Today: 2026 Medicare PFS · RVU26D
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Temp Package

Billed together on one claim

61645 36225 36223

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Price for scenario

San Jose Inpatient MD $777.28
Facility · Traditional Medicare 2 to resolve
San Jose Outpatient MD $777.28
Office · Traditional Medicare 2 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
$777.28
Total the claim is paid on
Medicare pays
$609.38
80%, less 2% sequestration
Patient owes
$155.46
20% coinsurance, once the Part B deductible is met
Billing rules changed it by
−$5,103.61
from $5,880.89 at full fee schedule

Before billing · 2 items to resolve

  • Bundled into 61645 36225

    NCCI denies 36225 billed with 61645. If it was a distinct service (different site, session or encounter), document that and add 59 or XE/XS/XP/XU.

  • Bundled into 61645 36223

    NCCI denies 36223 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. 36223 $0.00
    Place cath carotid/inom art
    Bundled into 61645
    Fee schedule $2,640.32
    • NCCI bundlingBundled into 61645 (NCCI) −$2,640.32
  2. 36225 $0.00
    Place cath subclavian art
    Bundled into 61645
    Fee schedule $2,463.29
    • NCCI bundlingBundled into 61645 (NCCI) −$2,463.29
  3. 61645 $777.28
    Perq art m-thrombect &/nfs
    No office rate
    Fee schedule $777.28
  4. Total allowed $777.28
    $5,880.89 fee schedule −$5,103.61 billing rules

Payment risks · 1

  • No office rate 61645

    CMS has no non-facility rate for 61645; it's normally done in a facility. If the MAC pays it in the office, it pays the facility rate (used here).

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)
36223 5.61 × 1.11 50.03 × 1.442
non-facility
 1.71 × 0.397 79.0492 33.4009 $2,640.32 0-day global Standard (2nd+ at 50%) 150% with 50 Not paid Not permitted
36225 5.61 × 1.11 46.36 × 1.442
non-facility
 1.69 × 0.397 73.7492 33.4009 $2,463.29 0-day global Standard (2nd+ at 50%) 150% with 50 Not paid Not permitted
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

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.