CPT 0486T
Contractor-priced
0486T · PFS Q2 2018 · Historical
No national PFS rate in Q2 2018
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Not at a published national rate. CPT 0486T carries status C (carrier-priced) in the Q2 2018 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Treat the blank amount as unpriced, not as $0.
PFS status evidence
Inspect PFS status evidence
- Code
- 0486T
- Release
- Q2 2018, revision 1
- Result
- Contractor-priced
Citations
-
Establishes the PFS status (C) and the resulting pathway for this code: contractor-priced.
Physician relative value file (PPRRVU)Q2 2018 · revision 1
Latest revision of this release
Release period: April 1 – June 30, 2018
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
PPRRVU18_APR.csv in rvu18b.zip (row 5,127)- hcpcs (col 1)
- 0486T
- modifier (col 2)
- blank
- status_code (col 4)
- C
SHA-256: 6a692625dad07579d7e9946e9b59265acc1cff8c6ed48d4391949735be04024b
Why is there no national PFS amount for 0486T?
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.
Other payment indicators (7)
Facility/non-facility: Not determined, 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.
Reconciling a contractor-priced payment for 0486T Copy link
There is no national allowed amount for 0486T, 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.
- Confirm which component the line carried before comparing anything: the same code prices three ways—globally, as a professional component with modifier 26, and as a technical component with modifier TC.
- Check whether a second side was billed separately—the published RVUs already price both sides, so there is no additional amount behind that line.
- 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 Q2 2018 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.
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).
Global period: what 0486T's fee already covers Copy link
The global surgery concept does not apply to this code.
Billing policy Copy link
What 0486T'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 | 2 | RVUs already reflect bilateral pricing. The published RVUs already account for a bilateral procedure—no additional bilateral adjustment applies on top of the fee schedule amount. |
| Professional/technical split | 1 | Splits into professional and technical. This procedure splits into a professional component (modifier 26) and a technical component (modifier TC), each separately payable. |
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 0486T.
Common payment questions Copy link
Why would a Medicare claim for 0486T 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
- 0486T splits into a professional component (modifier 26) and a technical component (modifier TC)—a claim for only one part needs that modifier to price correctly. 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.
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
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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.
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 0486T National PFS baseline: No national PFS rate (Q2 2018; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/0486T/2018/B