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Describe a service in plain words, or type a CPT/HCPCS code.

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Medicare expected-payment calculator

Enter a billing code, the service-location ZIP and the date of service. Get the Medicare allowed amount, how it splits between Medicare and coinsurance, and the CMS evidence behind each figure.

Claim details

CPT / HCPCS code
Service location
ZIP
Locality

Enter a service ZIP or select a locality for carrier pricing.

Date of service
Date of service
CMS release

CMS release: 2026 C

Place of service Office (non-facility) Facility Physician participation Participating Nonparticipating
Modifiers: None
Supplied modifier

Select a supplied modifier. Click it again to remove it.

Code does not support a professional/technical split (PCTC indicator 0).
Code does not support a professional/technical split (PCTC indicator 0).
Bilateral adjustment does not apply to this code (indicator 0).
Payable only if supporting documentation establishing the medical necessity of an assistant at surgery is submitted.
Payable only if supporting documentation establishing the medical necessity of an assistant at surgery is submitted.
Payable only if supporting documentation establishing the medical necessity of an assistant at surgery is submitted.
Payable only if supporting documentation establishing the medical necessity of an assistant at surgery is submitted.
Co-surgeon is not permitted for this code.
Team surgery is not permitted for this code.

Single-line modifiers only. Pricing -51? Use the MPPR calculator.

Payment answer

No national PFS rate for A9542

CMS marks this service status C: the Medicare Administrative Contractor (MAC) sets the amount. Carrier-priced codes require a specific Medicare locality. Select one below; there is no national MAC amount.

The available evidence does not establish a $0 allowance. Release 2026 C · status C (Carrier-priced)

Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

View the CMS evidence
Code
A9542
DOS
Not supplied
Locality
National (GPCI 1.000)
Service ZIP
Not supplied
Setting
Office (non-facility)
Participation
Participating provider
Modifiers
None
Units
1
Release
Q3 2026, revision 1
Sequestration
Shown separately from the allowed amount

Carrier-priced codes require a specific Medicare locality. Select one below; there is no national MAC amount.

Citations

  • Establishes the PFS status of the base code.

    Physician relative value file (PPRRVU)

    Q3 2026 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2026

    This status record alone does not establish an allowed amount or a coverage determination.

    Record details PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 13,899)
    hcpcs (col 1)
    A9542
    modifier (col 2)
    blank
    status_code (col 4)
    C

    SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

    Original source file

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