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Q4 2026 takes effect Oct 1, 2026. CMS published it early; dates of service before then are priced under the current release — see the current CPT 0198T rate.

CPT 0198T

Contractor-priced

0198T · PFS Q4 2026 · Upcoming

Contractor-published range

$75.14–$88.70

Participating · Office (non-facility) · Whole service

MAC-published fee schedules available in Localis: 20 of 144 payment localities. Missing data does not establish a $0 allowance.

No national PFS rate in Q4 2026

Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

Check for a published amount in your locality.

View contractor sources and effective dates

CMS published status C (carrier-priced) for CPT 0198T in the Q4 2026 Physician Fee Schedule, with no national PFS amount. These figures take effect for dates of service beginning Oct 1, 2026. Treat the blank amount as unpriced, not as $0.

Amount evidence: MAC-published fee schedules and effective dates. The PFS row establishes contractor pricing.

Inspect PFS status evidence
Code
0198T
Release
Q4 2026, revision 2
Result
Contractor-priced

Citations

  • Establishes the PFS status (C) and the resulting pathway for this code: contractor-priced.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

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

    Record details PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 312)
    hcpcs (col 1)
    0198T
    modifier (col 2)
    blank
    status_code (col 4)
    C

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

Compact facts

Why is there no national PFS amount for 0198T?

Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Carrier-priced: no national payment amount.

Payment considerations Copy link

Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.

NCCI same-day edits Applies Contractor pricing Applies
Other payment indicators (8)

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, MUE behavior: Not determined, Other fee-schedule routing: Does not apply.

Find the local Medicare amount for 0198T Copy link

Medicare sets this price locally

0198T has no single national Physician Fee Schedule amount. Use the ZIP, modifier, setting, and participation fields above to match it to a Medicare locality and the contractor amount we have on file.

Your practical estimate will appear here

We hold files from First_coast and Novitas across JH and JN, most recently effective Jan 1, 2026. A missing locality means our contractor coverage is incomplete—not that Medicare pays $0.

This is the published amount for this code—not necessarily the entire visit or procedure. A hospital may bill a separate facility charge, and other services, drugs, or supplies can add to the total.

Contractor-published source figures, not a national rate. Par = participating-provider amount Non-par = nonparticipating-provider amount C = technical component capped at the OPPS amount # = facility-setting amount
View all 40 published fee rows
Jurisdiction / locality Modifier Note Par Non-par Limiting charge Effective Source
JH · Arkansas, Area 13 CMS 07102-13 — — $75.14 $71.38 $82.09 Jan 1, 2026 Contractor file
JH · Arkansas, Area 13 CMS 07102-13 — # $24.93 $23.68 $27.23 Jan 1, 2026 Contractor file
JH · Colorado, Area 01 CMS 04112-01 — — $88.70 $84.27 $96.91 Jan 1, 2026 Contractor file
JH · Colorado, Area 01 CMS 04112-01 — # $26.51 $25.18 $28.96 Jan 1, 2026 Contractor file
JH · Louisiana, Area 01 CMS 07202-01 — — $80.81 $76.77 $88.29 Jan 1, 2026 Contractor file
JH · Louisiana, Area 01 CMS 07202-01 — # $25.81 $24.52 $28.20 Jan 1, 2026 Contractor file
JH · Louisiana, Area 99 CMS 07202-99 — — $77.10 $73.25 $84.24 Jan 1, 2026 Contractor file
JH · Louisiana, Area 99 CMS 07202-99 — # $25.37 $24.10 $27.72 Jan 1, 2026 Contractor file
JH · Mississippi, Area 00 CMS 07302-00 — — $75.42 $71.65 $82.40 Jan 1, 2026 Contractor file
JH · Mississippi, Area 00 CMS 07302-00 — # $25.09 $23.84 $27.42 Jan 1, 2026 Contractor file
JH · New Mexico, Area 05 CMS 04212-05 — — $79.32 $75.35 $86.65 Jan 1, 2026 Contractor file
JH · New Mexico, Area 05 CMS 04212-05 — # $25.72 $24.43 $28.09 Jan 1, 2026 Contractor file
JH · Oklahoma, Area 00 CMS 04312-00 — — $77.49 $73.62 $84.66 Jan 1, 2026 Contractor file
JH · Oklahoma, Area 00 CMS 04312-00 — # $25.30 $24.04 $27.65 Jan 1, 2026 Contractor file
JH · Texas, Area 09 CMS 04412-09 — — $83.94 $79.74 $91.70 Jan 1, 2026 Contractor file
JH · Texas, Area 09 CMS 04412-09 — # $26.01 $24.71 $28.42 Jan 1, 2026 Contractor file
JH · Texas, Area 11 CMS 04412-11 — — $84.33 $80.11 $92.13 Jan 1, 2026 Contractor file
JH · Texas, Area 11 CMS 04412-11 — # $26.11 $24.80 $28.52 Jan 1, 2026 Contractor file
JH · Texas, Area 15 CMS 04412-15 — — $84.10 $79.90 $91.89 Jan 1, 2026 Contractor file
JH · Texas, Area 15 CMS 04412-15 — # $26.06 $24.76 $28.47 Jan 1, 2026 Contractor file
JH · Texas, Area 18 CMS 04412-18 — — $84.46 $80.24 $92.28 Jan 1, 2026 Contractor file
JH · Texas, Area 18 CMS 04412-18 — # $26.42 $25.10 $28.87 Jan 1, 2026 Contractor file
JH · Texas, Area 20 CMS 04412-20 — — $78.69 $74.76 $85.97 Jan 1, 2026 Contractor file
JH · Texas, Area 20 CMS 04412-20 — # $25.49 $24.22 $27.85 Jan 1, 2026 Contractor file
JH · Texas, Area 28 CMS 04412-28 — — $83.70 $79.52 $91.45 Jan 1, 2026 Contractor file
JH · Texas, Area 28 CMS 04412-28 — # $26.06 $24.76 $28.47 Jan 1, 2026 Contractor file
JH · Texas, Area 31 CMS 04412-31 — — $88.19 $83.78 $96.35 Jan 1, 2026 Contractor file
JH · Texas, Area 31 CMS 04412-31 — # $26.35 $25.03 $28.78 Jan 1, 2026 Contractor file
JH · Texas, Area 99 CMS 04412-99 — — $81.17 $77.11 $88.68 Jan 1, 2026 Contractor file
JH · Texas, Area 99 CMS 04412-99 — # $25.70 $24.42 $28.08 Jan 1, 2026 Contractor file
JN · Florida, Area 03 CMS 09102-03 — — $85.88 $81.59 $93.83 Jan 1, 2026 Contractor file
JN · Florida, Area 03 CMS 09102-03 — # $26.67 $25.34 $29.14 Jan 1, 2026 Contractor file
JN · Florida, Area 04 CMS 09102-04 — — $88.15 $83.74 $96.30 Jan 1, 2026 Contractor file
JN · Florida, Area 04 CMS 09102-04 — # $27.31 $25.94 $29.83 Jan 1, 2026 Contractor file
JN · Florida, Area 99 CMS 09102-99 — — $82.02 $77.92 $89.61 Jan 1, 2026 Contractor file
JN · Florida, Area 99 CMS 09102-99 — # $26.14 $24.83 $28.55 Jan 1, 2026 Contractor file
JN · Puerto Rico, Area 20 CMS 09202-20 — — $85.20 $80.94 $93.08 Jan 1, 2026 Contractor file
JN · Puerto Rico, Area 20 CMS 09202-20 — # $26.11 $24.80 $28.52 Jan 1, 2026 Contractor file
JN · U.S. Virgin Islands, Area 50 CMS 09202-50 — — $85.20 $80.94 $93.08 Jan 1, 2026 Contractor file
JN · U.S. Virgin Islands, Area 50 CMS 09202-50 — # $26.11 $24.80 $28.52 Jan 1, 2026 Contractor file

The authenticated MAC fees API returns the same source rows. ZIP5s that span localities are flagged and use only the crosswalk's dominant locality until ZIP+4 overrides are available.

Reconciling a contractor-priced payment for 0198T Copy link

There is no national allowed amount for 0198T, so every reconciliation of this line runs against the MAC fee schedule that was in force for the date of service rather than against a national baseline.

What to reconcile

  • Compare the paid amount against the MAC fee schedule in force for the date of service; there is no national allowed amount here to reconcile against.
  • Check for documentation on file before appealing an assistant-at-surgery denial: payment on the -80 or -AS line is restricted for this procedure unless medical necessity is established.
  • Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.

Nearby payment lines

National Q4 2026 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

No comparison lines are present in this release.

Check an actual payment Model this code in a contract

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

Payment rules

Global period: what 0198T's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Billing policy Copy link

What 0198T's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code.

Policy Value What it means
Bilateral surgery 0 No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure.
Assistant at surgery 0 Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity.
Co-surgeons 0 Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure.
Team surgery 0 Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure.
Multiple procedures 0 No reduction. No payment reduction applies when this procedure is billed with other procedures on the same date—each is treated as unrelated.
Professional/technical split 0 No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service.

Can you bill it with another code? 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 between it and 0198T.

See every current NCCI pair for 0198T →

Billing together (NCCI edits) Copy link

NCCI Q4 2026

Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.

Not separately payable with 0198T on the same date of service—no modifier bypasses the edit (modifier indicator 0)

36591 36591 denies
36592 36592 denies
96523 96523 denies

Separately payable with 0198T only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

0329T 0198T denies
92100 0198T denies

Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.

Check a paired code or view all 5 NCCI pairs →

Common payment questions Copy link

Why would a Medicare claim for 0198T be denied or paid less?

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

  • Its status indicator is C (carrier-priced)—Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. See status indicators
  • 3 codes form NCCI pairs with 0198T 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
  • 2 codes pair with 0198T 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
  • Bilateral surgery: no bilateral adjustment. See billing policy
  • Assistant at surgery: restricted without documentation. See billing policy
  • Co-surgeons: not permitted. See billing policy
  • Team surgery: not permitted. See billing policy

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.

History
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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Source & method

Show sources

Contractor amounts come from the MAC-published schedules and effective dates identified above. The PFS file establishes contractor pricing. Releases are immutable: historical evidence remains tied to the specified release. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 312)

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

CPT 0198T National PFS baseline: No national PFS rate (Q4 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/0198T/2026/D