CPT 0472T
Contractor-priced
0472T · PFS Q2 2020 · Historical
No national PFS rate in Q2 2020
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
CPT 0472T has no published national rate. It carries status C (carrier-priced) in the Q2 2020 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank amount means unpriced, not $0.
PFS status evidence
Inspect PFS status evidence
- Code
- 0472T
- Release
- Q2 2020, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)Q2 2020 · revision 1
Latest revision of this release
Release period: April 1 – June 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.
Record details
PPRRVU20_APR.csv in rvu20b-updated-05012020.zip (row 5,439)- hcpcs (col 1)
- 0472T
- modifier (col 2)
- blank
- status_code (col 4)
- C
SHA-256: 672d21e247262386ad5b386092de9835fecec65fabbeaae050718f9afeef097b
Why is there no national PFS amount for 0472T?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
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 (9)
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.
Why would a Medicare claim for 0472T 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.
Which billing rules and modifiers apply? Copy link
Global period: what 0472T's fee already covers Copy link
The global surgery concept does not apply to this code.
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.
Did this answer your question about CPT 0472T?
We're building this out in the open. Tell us what you were actually trying to work out and we'll either answer you directly or build the page that does.
Source & method
Show sources
Hide
Contractor amounts come from the MAC-published schedules and effective dates shown above. The PFS file shows this code is priced by the contractor. 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.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
The citation names the release, so anyone can check it even after CMS publishes a newer one.
CPT 0472T National PFS baseline: No national PFS rate (Q2 2020; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/0472T/2020/B