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CPT 00864 Medicare anesthesia rate

Priced using anesthesia methodology

00864 · PFS Q3 2025 · Historical

Illustrative example

~$407.00

Source

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.

base_units
8
time_units
12
anesthesia_cf
20.35
amount
$407.00

time_units = time_minutes / 15, rounded to one decimal place.

The anesthesia conversion factor is CMS's published locality-adjusted value.

Citations

180-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 8—set by CMS for this code and the same in every locality. One time unit is 15 minutes, rounded to one decimal, so a 180-minute case adds 12 time units.

View CMS source and method

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
00864
Release
Q3 2025, 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 RVU25CJuly 1 – September 30, 2025

    This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

    PPRRVU2025_Jul.csv row 141 in rvu25c-updated-06-05-2025.zip

    In the CMS file

    Loading rows 139–143 of PPRRVU2025_Jul.csv…

    Download rvu25c-updated-06-05-2025.zip from CMS File fingerprint b7937472967288d5c4dcf43ecbc5d2d792e97d768c9f5ec9b1e88a99f3d0bbe7

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CPT 00864 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 $407.00 for a 180-minute case in Dallas, TX under the Q3 2025 release, before sequestration.

Why is there no national PFS amount for 00864?

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.

Contract rate as % of Medicare Copy link

Arbitration outcomes for 00864 are coming Join the waitlist →

Which billing rules and modifiers apply? Copy link

CMS's surgical and split-billing indicators don't adjust 00864's amount.

CMS RVU25CJuly 1 – September 30, 2025

Can you bill it with another code? Copy link

This code

00864

See every current NCCI pair for 00864 →

Source & method Copy link

The PFS file shows this code is priced as anesthesia. The estimate uses the base units, case length, and locality conversion factor shown beside it.

  1. 01 PPRRVU2025_Jul.csv · Q3 2025 (RVU25C) · row 141—priced as anesthesia
    Source
    Physician relative value file (PPRRVU), Q3 2025 release
    Effective
    July 1 – September 30, 2025
    Locator
    PPRRVU2025_Jul.csv in rvu25c-updated-06-05-2025.zip · row 141 of 19,029 · via CMS
    Fields read
    Status J (col 4)
    SHA-256 b7937472967288d5…
  2. 02 Physician & Other Practitioners · CY2024—volume and who bills it limits
    Source
    CMS Physician & Other Practitioners dataset
    Effective
    Calendar-year snapshot, on a different cycle from the Q3 2025 fee schedule
    Doesn’t establish
    Medicare Advantage, Medicaid or commercial volume.
    Note
    The dataset suppresses rows under 11 beneficiaries.

Cite this rate

CPT 00864 National PFS baseline: No national PFS rate (Q3 2025; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU25C, PPRRVU2025_Jul.csv row 141. Localis. https://localishealth.com/cpt/00864/2025/C

Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON

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.

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Usage and related codes Copy link

In CY2024, 00864 ranked #2,466 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Services
4,117
Allowed
$1.9M
Beneficiaries
2,698

CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits). Localis groups related codes for payment research; the grouping isn't the AMA's code families.