Contractor-priced
0373T · PFS Q4 2015 · Historical
No national PFS rate in Q4 2015
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Check for a published amount in your locality.
PFS status evidence
Inspect PFS status evidence
- Code
- 0373T
- Release
- Q4 2015, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU15DOctober 1 – December 31, 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_OCT05_V1001.csv row 4,645 in rvu15d.zip
In the CMS file
Loading rows 4,643–4,647 of PPRRVU15_OCT05_V1001.csv…
Download rvu15d.zip from CMS File fingerprint
302a55af716b26df5b42e80da7b2bd7cf5268007658df88133553f5e4e75523f
CPT 0373T has no published national rate. It carries status C (carrier-priced) in the Q4 2015 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 0373T?
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 0373T: 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 0373T 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
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 RVU15DOctober 1 – December 31, 2015
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 0373T Copy link
What to check (3)
There is no national allowed amount for 0373T, 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.
- 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).
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.
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01 PPRRVU15_OCT05_V1001.csv · Q4 2015 (RVU15D) · row 4,645—priced by the contractor
- Effective
- October 1 – December 31, 2015
- Locator
- PPRRVU15_OCT05_V1001.csv in rvu15d.zip · row 4,645 of 16,095 · via CMS
- Fields read
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Status C (col 4)SHA-256 302a55af716b26df…
Cite this rate
CPT 0373T National PFS baseline: No national PFS rate (Q4 2015; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU15D, PPRRVU15_OCT05_V1001.csv row 4,645. Localis. https://localishealth.com/cpt/0373T/2015/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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