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CPT 00926 Medicare anesthesia rate

Priced using anesthesia methodology

00926 · PFS Q4 2026

Illustrative example

~$163.52

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
4
time_units
4
anesthesia_cf
20.44
amount
$163.52

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 RVU26DOctober 1 – December 31, 2026revision 2

    PPRRVU2026_Oct_nonQPP.csv row 162 in rvu26d-updated-08-26-2026.zip

    A HCPCS
    00926
    D Status code
    J
    Z Conversion factor
    33.4009
    In the CMS file

    Loading rows 160–164 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

  • The GPCIs

    Geographic practice cost indices (GPCI)CMS RVU26DOctober 1 – December 31, 2026revision 2

    GPCI2026.csv row 99 in rvu26d-updated-08-26-2026.zip

    E Work GPCI
    1.009
    F PE GPCI
    0.996
    G MP GPCI
    0.858
    In the CMS file

    Loading rows 97–101 of GPCI2026.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 7850e2987d12e46930e49033f96829b5ae11f60dd1f19965329b38cf08b05264

  • Anesthesia conversion factors (ANES)

    CMS RVU26DOctober 1 – December 31, 2026revision 2

    ANES2026.csv row 97 in rvu26d-updated-08-26-2026.zip

    E Anesthesia CF (non-QPP)
    20.4400
    D Anesthesia CF (QPP)
    20.5400
    In the CMS file

    Loading rows 95–99 of ANES2026.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint c4d61aa42106998615db595414cebb13f48d68484edf5fa339de9cb0f8abf8a8

  • Anesthesia base units by CPT code

    Q1 2022January 1 – March 31, 2022

    Section 508 compliant version of CY_2022_Anesthesia_Base_Units_110921.txt row 140 in 2022-anesthesia-base-units-cpt-code.zip

    B Base units
    4

    Download 2022-anesthesia-base-units-cpt-code.zip from CMS File fingerprint ebbf7d42ecaf759c280f0b9fced5ea71dd16505a0563bb7c942cee068c797fde

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.

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
00926
Release
Q4 2026, revision 2
Result
Priced using anesthesia methodology

Citations

  • Shows this code’s PFS status (J). Result: Priced using anesthesia methodology.

    Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

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

    PPRRVU2026_Oct_nonQPP.csv row 162 in rvu26d-updated-08-26-2026.zip

    In the CMS file

    Loading rows 160–164 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

Report a problem

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 $163.52 for a 60-minute case in Dallas, TX under the Q4 2026 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.

Why would a Medicare claim for 00926 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • 143 codes form NCCI pairs with 00926 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
  • 162 codes pair with 00926 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

CMS RVU26DOctober 1 – December 31, 2026revision 2

Can you bill it with another code? Copy link

00926 has 305 NCCI pairs (Q4 2026).

This code

00926

Modifier indicator 0

143 pairs

No modifier bypasses the edit

Modifier indicator 1

162 pairs

Only with an appropriate, documented modifier

All 305 NCCI pairs for 00926 →

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 PPRRVU2026_Oct_nonQPP.csv · Q4 2026 (RVU26D) · row 162—priced as anesthesia
    Source
    Physician relative value file (PPRRVU), Q4 2026 release
    Effective
    October 1 – December 31, 2026
    Locator
    PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip · row 162 of 19,453 · via CMS
    Fields read
    Status J (col 4)
    SHA-256 4d0d3f19bd954ffc…
  2. 02 NCCI · Q4 2026—the code-pair edits
    Source
    National Correct Coding Initiative (NCCI)
    Effective
    Same quarter as the Q4 2026 rate
  3. 03 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 Q4 2026 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 (Q4 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26D, PPRRVU2026_Oct_nonQPP.csv row 162. Localis. https://localishealth.com/cpt/00926/2026/D

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.