Contractor-priced
0409T · PFS Q3 2020 · Historical
No national PFS rate in Q3 2020
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
PFS status evidence
Inspect PFS status evidence
- Code
- 0409T
- Release
- Q3 2020, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU20CJuly 1 – September 30, 2020
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU20_V0618.csv row 5,416 in rvu20c-updated-06192020.zip
In the CMS file
Loading rows 5,414–5,418 of PPRRVU20_V0618.csv…
Download rvu20c-updated-06192020.zip from CMS File fingerprint
ebde66539c09d959dffb822c31f25e7c77955ac2e54e8c120994bef894ac5342
CPT 0409T has no published national rate. It carries status C (carrier-priced) in the Q3 2020 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 0409T?
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's surgical and split-billing indicators don't adjust 0409T's amount.
Global surgery period XXX (does not apply).
Why would a Medicare claim for 0409T 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 RVU20CJuly 1 – September 30, 2020
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 0409T Copy link
What to check (3)
There is no national allowed amount for 0409T, 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.
- 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); 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 PPRRVU20_V0618.csv · Q3 2020 (RVU20C) · row 5,416—priced by the contractor
- Effective
- July 1 – September 30, 2020
- Locator
- PPRRVU20_V0618.csv in rvu20c-updated-06192020.zip · row 5,416 of 17,320 · via CMS
- Fields read
-
Status C (col 4)SHA-256 ebde66539c09d959…
Cite this rate
CPT 0409T National PFS baseline: No national PFS rate (Q3 2020; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU20C, PPRRVU20_V0618.csv row 5,416. Localis. https://localishealth.com/cpt/0409T/2020/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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