Contractor-priced
0490T · PFS Q1 2024 · Historical
No national PFS rate in Q1 2024
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
- 0490T
- Release
- Q1 2024, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU24AJanuary 1 – March 8, 2024revision 1, since superseded
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU24_JAN.csv row 6,205 in rvu24a-updated-04-01-2024.zip
In the CMS file
Loading rows 6,203–6,207 of PPRRVU24_JAN.csv…
Download rvu24a-updated-04-01-2024.zip from CMS File fingerprint
034f3aa88a63e6f7ca3859c09b3945dce139171a6fc5a710300fc7b815e9b65b
CPT 0490T has no published national rate. It carries status C (carrier-priced) in the Q1 2024 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 0490T?
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
Payment rules for 0490T Copy link
Other payment indicators (9)
Why would a Medicare claim for 0490T 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.
Global period: what 0490T's fee already covers Copy link
The fee covers pre-operative and post-operative work on the day of the procedure only—there is no follow-up window afterward. A visit the next day is separately payable.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
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.
Reconciling a contractor-priced payment for 0490T Copy link
There is no national allowed amount for 0490T, 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 check
- 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 the visit date: this code carries no follow-up window, so a related visit the day after the procedure is separately payable and should not have bundled.
- 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).
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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Source & method
Show sources
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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.
Cite this rate
The citation names the release, so anyone can check it even after CMS publishes a newer one.
CPT 0490T National PFS baseline: No national PFS rate (Q1 2024; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU24A, PPRRVU24_JAN.csv row 6,205. Localis. https://localishealth.com/cpt/0490T/2024/A/1