Priced using anesthesia methodology
01404 · PFS Q3 2015 · Historical
Illustrative example
~$247.61
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 01404’s RVUs, PFS status and conversion factor Physician relative value file (PPRRVU)CMS RVU15CJuly 1 – September 30, 2015
PPRRVU15_UP0.V0515.csv
row 4,378
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
90-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 5—set by CMS for this code and the same in every locality. One time unit is 15 minutes, rounded to one decimal, so a 90-minute case adds 6 time units.
CPT 01404 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 $247.61 for a 90-minute case in Dallas, TX under the Q3 2015 release, before sequestration.
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
- 01404
- 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 4,378 in rvu15c.zip
In the CMS file
Loading rows 4,376–4,380 of PPRRVU15_UP0.V0515.csv…
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f1b114a70a3e0897273d46b1bfe0eca991d563f8c35c7a652e9f0c8472b2862a
Why is there no national PFS amount for 01404?
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)
Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.
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.
Usage and related codes Copy link
How often 01404 is billed Copy link
Across Original Medicare in CY2024, 01404 ranked #5,951 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 Q3 2015 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 01404 National PFS baseline: No national PFS rate (Q3 2015; participating; whole service; GPCI 1.000; sequestration excluded). CMS RVU15C, PPRRVU15_UP0.V0515.csv row 4,378. Localis. https://localishealth.com/cpt/01404/2015/C