Priced using anesthesia methodology
00926 · PFS Q3 2015 · Historical
Illustrative example
~$180.08
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 00926’s RVUs, PFS status and conversion factor Physician relative value file (PPRRVU)CMS RVU15CJuly 1 – September 30, 2015
PPRRVU15_UP0.V0515.csv
row 4,316
in rvu15c.zip
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File fingerprint The GPCIs Geographic practice cost indices (GPCI)CMS RVU15CJuly 1 – September 30, 2015
CY2015_GPCIs.csv
row 78
in rvu15c.zip
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File fingerprint Anesthesia conversion factors (ANES) CMS RVU15CJuly 1 – September 30, 2015
ANES_2015_UP05_V0701.csv
row 78
in rvu15c.zip
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File fingerprint
Source
In the CMS file
f1b114a70a3e0897273d46b1bfe0eca991d563f8c35c7a652e9f0c8472b2862a
In the CMS file
ce389037033017a10b7796f84dc6b74289b96eaff624513d7e97db9a2688a7a3
In the CMS file
8892bb44133f8ccd0c3f615b098e13107fb5e0f950c8e0c4a9302719b3456053
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 4—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
- 00926
- Release
- Q3 2015, 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 RVU15CJuly 1 – September 30, 2015
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU15_UP0.V0515.csv row 4,316 in rvu15c.zip
In the CMS file
Loading rows 4,314–4,318 of PPRRVU15_UP0.V0515.csv…
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f1b114a70a3e0897273d46b1bfe0eca991d563f8c35c7a652e9f0c8472b2862a
CPT 00926 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 $180.08 for a 60-minute case in Dallas, TX under the Q3 2015 release, before sequestration.
Why is there no national PFS amount for 00926?
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 00926 are coming Join the waitlist →
Which billing rules and modifiers apply? Copy link
CMS's surgical and split-billing indicators don't adjust 00926's amount.
CMS RVU15CJuly 1 – September 30, 2015
Can you bill it with another code? Copy link
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.
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01 PPRRVU15_UP0.V0515.csv · Q3 2015 (RVU15C) · row 4,316—priced as anesthesia
- Effective
- July 1 – September 30, 2015
- Locator
- PPRRVU15_UP0.V0515.csv in rvu15c.zip · row 4,316 of 16,089 · via CMS
- Fields read
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Status J (col 4)SHA-256 f1b114a70a3e0897…
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02 Physician & Other Practitioners · CY2024—volume and who bills it limits
- Effective
- Calendar-year snapshot, on a different cycle from the Q3 2015 fee schedule
- Doesn’t establish
- Medicare Advantage, Medicaid or commercial volume.
- Note
- The dataset suppresses rows under 11 beneficiaries.
Cite this rate
CPT 00926 National PFS baseline: No national PFS rate (Q3 2015; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU15C, PPRRVU15_UP0.V0515.csv row 4,316. Localis. https://localishealth.com/cpt/00926/2015/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, 00926 ranked #4,629 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
- Services
- 1,079
- Allowed
- $156,081
- Beneficiaries
- 762
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.