CPT 37226 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Cardiovascular System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 37226 |
National average reimbursement for CPT 37226 by major payers:
$9,711.95
$13,008.88
$12,774.86
$13,581.50
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 37226 | ||||||
United | 37226 | $11424.00 | 1710940218 - DENVER MID-TOWN SURGERY CENTER LTD | 752548180 - DENVER MIDTOWN SURGERY CENTER LTD | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $10493.00 | 1306421268 - COLORADO UROLOGIC SURGERY CENTER, LLC, COLORADO UROLOGIC SURGERY CENTER | 851926897 - (CO) COLORADO UROLOGIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $9088.00 | 1447788120 - NORCAL ORTHOPEDIC SURGERY CENTER, LLC | 821046949 - (CA) NORCAL ORTHOPEDIC SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $4500.00 | 1700921251 - ELTRA LLC | 810598060 - (NJ) ELTRA LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $7426.00 | 1942231204 - SURGICAL INSTITUTE, LLC | 810911558 - (NJ) SURGICAL INSTITUTE LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $3400.00 | 1972549491 - UNION CITY ASC LLC, SUMMIT ENDOSCOPY CENTER | 621625423 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $3432.00 | 1972808186 - PALMETTO ENDOSCOPY SUITE, LLC | 272203762 - (SC) PALMETTO ENDOSCOPY SUITE LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $6768.00 | 1386898435 - COLUMBIA GORGE SURGERY CENTER, LLC | 261819228 - (OR) COLUMBIA GORGE SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $3900.00 | 1396727418 - ENDOSCOPY CENTER OF LITTLE ROCK,LLC, RIC LR LLC | 20703428 - (AR) ENDOSCOPY CENTER OF LITTLE ROCKLLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $914.00 | 1295494359 - ATLANTIC SC LLC | 832941937 - (NY) ATLANTIC SC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $4100.00 | 1063417285 - LARGO ENDOSCOPY CENTER LP, TAMPA BAY REGIONAL SURGERY CENTER | 731631684 - (FL) LARGO ENDOSCOPY CENTER LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $8000.00 | 1457379158 - HUDSON CROSSING SURGERY CENTER, LLC, HUDSON CROSSING SURGERY CENTER | 364533553 - (NJ) HUDSON CROSSING SURGICAL CENTER | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $1256.00 | 1467472688 - WEST CLINIC ASTC, WEST CLINIC, PC | 621526296 - THE WEST CLINIC, PLLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $4606.00 | 1073155834 - REGENCY AMBULATORY SURGERY CENTER ONE, LLC | 843154819 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 37226 | $5894.00 | 1063935286 - CHESNUT INSTITUTE OF COSMETIC & RECONSTRUCTIVE SURGERY | 821592877 - (WA) CLINIC 5C | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 37226 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 37226 code is part of the Surgery services used for Surgical Procedures on the Cardiovascular System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 37226 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 37224-CPT | High | Revascularization, Endovascular, Open Or Percutaneous, Femoral, Popliteal Artery(S), Unilateral; With Transluminal Angioplasty |
| 37225-CPT | High | Revascularization, Endovascular, Open Or Percutaneous, Femoral, Popliteal Artery(S), Unilateral; With Atherectomy, Includes Angioplasty Within The Same Vessel, When Performed |
| 37226-CPT | High | Revascularization, Endovascular, Open Or Percutaneous, Femoral, Popliteal Artery(S), Unilateral; With Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel, When Performed |
| 37227-CPT | High | Revascularization, Endovascular, Open Or Percutaneous, Femoral, Popliteal Artery(S), Unilateral; With Transluminal Stent Placement(S) And Atherectomy, Includes Angioplasty Within The Same Vessel, When Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 37226. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 37226 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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