Contractor-priced
0237T · PFS Q3 2014 · Historical
No national PFS rate in Q3 2014
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
PFS status evidence
Inspect PFS status evidence
- Code
- 0237T
- Release
- Q3 2014, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU14CJuly 1 – September 30, 2014
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU14_V0515.csv row 4,474 in rvu14c.zip
In the CMS file
Loading rows 4,472–4,476 of PPRRVU14_V0515.csv…
Download rvu14c.zip from CMS File fingerprint
c77da0d012ff73dec8680d5f6f50582fc7e72005bc55edb2f131a02f0b1c293c
CPT 0237T has no published national rate. It carries status C (carrier-priced) in the Q3 2014 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank amount means unpriced, not $0.
Why is there no national PFS amount for 0237T?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to 0237T: GLOB DAYS YYY (contractor decides).
Contractor decides
GLOB DAYS
YYY
Your Medicare Administrative Contractor decides whether a global period applies and sets its length when it prices the code. The result is 0, 10, or 90 days.
Why would a Medicare claim for 0237T 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
- 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.
CMS RVU14CJuly 1 – September 30, 2014
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 0237T Copy link
What to check (4)
There is no national allowed amount for 0237T, 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.
- 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.
- Ask the MAC which global period it assigned: the contractor sets the follow-up window for this code, so whether a post-operative visit should have paid depends on the contractor that priced it.
- 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.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Medicare Claims Processing Manual (Pub. 100-04); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
Source & method Copy link
The PFS file shows this code is priced by the contractor. Its amounts come from the MAC-published schedules and effective dates shown above.
-
01 PPRRVU14_V0515.csv · Q3 2014 (RVU14C) · row 4,474—priced by the contractor
- Effective
- July 1 – September 30, 2014
- Locator
- PPRRVU14_V0515.csv in rvu14c.zip · row 4,474 of 15,901 · via CMS
- Fields read
-
Status C (col 4)SHA-256 c77da0d012ff73de…
Cite this rate
CPT 0237T National PFS baseline: No national PFS rate (Q3 2014; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU14C, PPRRVU14_V0515.csv row 4,474. Localis. https://localishealth.com/cpt/0237T/2014/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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