Priced using anesthesia methodology
00172 · PFS Q4 2021 · Historical
Illustrative example
~$214.40
Formula (base_units + time_units) × anesthesia_cf Localis calculated this from CMS’s published inputs. Select an underlined value to see where it comes from. time_units = time_minutes / 15, rounded to one decimal place. The anesthesia conversion factor is CMS's published locality-adjusted value. Citations 00172’s RVUs, PFS status and conversion factor Physician relative value file (PPRRVU)CMS RVU21DOctober 1 – December 31, 2021
PPRRVU21_OCT.csv
row 5,041
in rvu21d.zip
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File fingerprint The GPCIs Geographic practice cost indices (GPCI)CMS RVU21DOctober 1 – December 31, 2021
GPCI2021.csv
row 102
in rvu21d.zip
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File fingerprint Anesthesia conversion factors (ANES) CMS RVU21DOctober 1 – December 31, 2021
ANES2021.csv
row 100
in rvu21d.zip
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File fingerprint
Source
In the CMS file
f1972bd23bdc51795ceba7d536bb413a0ba0b47fad8c2ed594e7ee7799877297
In the CMS file
28f1a06af5324ac2feaeab21e65a4a74eaf793af8939abc64782776ff6e4128e
In the CMS file
42cf809d2405377a43a1227b10fe996e24f2fd0afe451b30f94a726a02950fb5
60-minute example case in Dallas, TX
Anesthesia has no single national rate—payment is (base units + time units) × the locality's anesthesia conversion factor. This example is before sequestration. Enter the service-location ZIP and case length for a local estimate.
Base units 6—set by CMS for this code and the same in every locality. One time unit is 15 minutes, rounded to one decimal, so a 60-minute case adds 4 time units.
Amount evidence: base units, time units, and the locality conversion factor, shown in the estimate. The PFS row shows this code is priced as anesthesia.
Inspect PFS status evidence
- Code
- 00172
- Release
- Q4 2021, revision 1
- Result
- Priced using anesthesia methodology
Citations
-
Shows this code’s PFS status (J). Result: Priced using anesthesia methodology.
Physician relative value file (PPRRVU)CMS RVU21DOctober 1 – December 31, 2021
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU21_OCT.csv row 5,041 in rvu21d.zip
In the CMS file
Loading rows 5,039–5,043 of PPRRVU21_OCT.csv…
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f1972bd23bdc51795ceba7d536bb413a0ba0b47fad8c2ed594e7ee7799877297
CPT 00172 is an anesthesia code, so Medicare has no single national rate: payment is (base units + time units) × the locality's anesthesia conversion factor—for example, about $214.40 for a 60-minute case in Dallas, TX under the Q4 2021 release, before sequestration.
Why is there no national PFS amount for 00172?
Its status indicator is J (anesthesia). Medicare prices this under the anesthesia formula—(base units + time units) × the locality anesthesia conversion factor—not the standard RVU formula. Choose a locality to see that factor.
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 (10)
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.
How has it changed? Copy link
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.
What it means outside Medicare Copy link
Usage and related codes Copy link
How often 00172 is billed Copy link
Across Original Medicare in CY2024, 00172 ranked #7,190 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q4 2021 fee schedule above.
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Source & method
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The anesthesia estimate uses the base units, case length, and locality conversion factor shown beside it. The PFS file shows this code is priced as anesthesia. 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 00172 National PFS baseline: No national PFS rate (Q4 2021; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU21D, PPRRVU21_OCT.csv row 5,041. Localis. https://localishealth.com/cpt/00172/2021/D