CPT 38226
Bundled / not separately paid
38226 · PFS Q4 2026
Status B is not separately payable under the PFS.
CPT 38226 has no published national rate. It carries status B (bundled) in the Q4 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.
PFS status evidence
Inspect PFS status evidence
- Code
- 38226
- Release
- Q4 2026, revision 2
- Result
- Bundled / not separately paid
Citations
-
Shows this code’s PFS status (B). Result: Bundled / not separately paid.
Physician relative value file (PPRRVU)Q4 2026 · revision 2
Latest revision of this release
Release period: October 1 – December 31, 2026
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
PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 4,726)- hcpcs (col 1)
- 38226
- modifier (col 2)
- blank
- status_code (col 4)
- B
SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626
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 (8)
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, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.
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
- 112 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
- More than 1 unit per patient per date of service exceeds 38226's Medically Unlikely Edit (MUE) limit. 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.
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.
Codes to compare
National Q4 2026 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).
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 Q4 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 112.
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.
Check a paired code or view all 131 NCCI pairs →
Medically Unlikely Edit (MUE) limit: 1 unit per patient per date of service.
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 Q4 2026 release (effective October 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.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
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 (Q4 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/38226/2026/D