Bundled / not separately paid
38226 · PFS Q3 2026 · Historical
Status B is not separately payable under the PFS.
CMS RVU26CJuly 1 – September 30, 2026
PFS status evidence
Inspect PFS status evidence
- Code
- 38226
- Release
- Q3 2026, revision 1
- Result
- Bundled / not separately paid
Citations
-
Shows this code’s PFS status (B). Result: Bundled / not separately paid.
Physician relative value file (PPRRVU)CMS RVU26CJuly 1 – September 30, 2026
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU2026_Jul_nonQPP.csv row 4,666 in rvu26c-updated-06-30-2026.zip
In the CMS file
Loading rows 4,664–4,668 of PPRRVU2026_Jul_nonQPP.csv…
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CPT 38226 has no published national rate. It carries status B (bundled) in the Q3 2026 release. Medicare folds payment for this code into the service it is incident to, never onto its own line. The blank amount means unpriced, not $0.
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
Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.
Other payment indicators (9)
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
- 19 codes form NCCI pairs with 38226 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
- 111 codes pair with 38226 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
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.
Which billing rules and modifiers apply? Copy link
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
Check a pair of codes 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 for the pair.
Billing together (NCCI edits) Copy link
NCCI Q3 2026Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.
Not separately payable with 38226 on the same date of service—no modifier bypasses the edit (modifier indicator 0)
Showing 3 of 19.
Separately payable with 38226 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)
Showing 3 of 111.
Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.
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 check
- 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.
Compare against 38225, 38227 and 38228: their amounts are in Related codes.
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).
How has it changed? Copy link
Rate history by release Copy link
National Office (non-facility) amount for 38226 across quarterly releases.
| Release | Status | Office | Facility |
|---|---|---|---|
| Q4 2026 Oct 1, 2026 – present | 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.
Usage and related codes Copy link
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Source & method
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This page uses CMS's Medicare Physician Fee Schedule Q3 2026 release (effective July 2026). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.
Cite this rate
The citation names the release, so anyone can check it even after CMS publishes a newer one.
CPT 38226 National PFS baseline: No national PFS rate (Q3 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26C, PPRRVU2026_Jul_nonQPP.csv row 4,666. Localis. https://localishealth.com/cpt/38226/2026/C