CPT 38226
Bundled / not separately paid
38226 · PFS Q1 2025 · Historical
Status B is not separately payable under the PFS.
Not at a published national rate. CPT 38226 carries status B (bundled) in the Q1 2025 release. Medicare folds payment for this code into the service it is incident to, never onto its own line. Treat the blank amount as unpriced, not as $0.
PFS status evidence
Inspect PFS status evidence
- Code
- 38226
- Release
- Q1 2025, revision 1
- Result
- Bundled / not separately paid
Citations
-
Establishes the PFS status (B) and the resulting pathway for this code: bundled / not separately paid.
Physician relative value file (PPRRVU)Q1 2025 · revision 1
Latest revision of this release
Release period: January 1 – March 31, 2025
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
Record details
PPRRVU25_JAN.csv in rvu25a-updated-01-10-2025.zip (row 10,482)- hcpcs (col 1)
- 38226
- modifier (col 2)
- blank
- status_code (col 4)
- B
SHA-256: c0539b47cbc042fd1b69798e6dd911219f4893bb5be793ae1d1771e7a7151a54
Why is there no national PFS amount for 38226?
Its status indicator is B (bundled). Medicare folds payment for this code into the service it is incident to, never onto its own line. Status B is not separately payable under the PFS.
Payment considerations Copy link
Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.
Other payment indicators (10)
Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.
Why a 38226 line may not pay separately Copy link
CMS publishes no separately payable amount for 38226 in this release, so reconciling the line means establishing which status governed the date of service rather than chasing a fee-schedule difference.
What to reconcile
- Confirm the status that governed the date of service before working this line as a short payment—CMS publishes no separately payable fee-schedule amount for it in this release.
- Check the place of service: CMS publishes no office (non-facility) practice-expense amount for this code, so it prices in a facility setting only.
- Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.
Nearby payment lines
National Q1 2025 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Practice Expense methodology (cms.gov).
Global period: what 38226's fee already covers Copy link
The global surgery concept does not apply to this code.
Can you bill it with another code? Copy link
Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 38226.
Common payment questions Copy link
Why would a Medicare claim for 38226 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is B (bundled)—Medicare folds payment for this code into the service it is incident to, never onto its own line. See status indicators
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
Rate history by release Copy link
National non-facility amount for 38226 across quarterly releases.
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q4 2026 takes effect Oct 1, 2026 | B | — | — |
| Q3 2026 Jul 1, 2026 – Sep 30, 2026 | B | — | — |
| Q2 2026 Apr 1, 2026 – Jun 30, 2026 | B | — | — |
| Q1 2026 Jan 1, 2026 – Mar 31, 2026 | B | — | — |
| Q4 2025 Oct 1, 2025 – Dec 31, 2025 | B | — | — |
| Q3 2025 Jul 1, 2025 – Sep 30, 2025 | B | — | — |
| Q2 2025 Apr 1, 2025 – Jun 30, 2025 | B | — | — |
| Q1 2025 Jan 1, 2025 – Mar 31, 2025 | B | — | — |
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
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Source & method
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This page uses CMS's Medicare Physician Fee Schedule Q1 2025 release (effective January 2025). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This citation identifies the source release, so its evidence remains reproducible after a newer release lands.
CPT 38226 National PFS baseline: No national PFS rate (Q1 2025; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/38226/2025/A