CPT 0627T Medicare carrier-priced amount: $241.03–$314.19 on file (Q4 2026)

Contractor-priced

0627T · PFS Q4 2026

Contractor-published range

$241.03–$314.19

Participating · Office (non-facility) · Whole service

MAC-published fee schedules available in Localis: 28 of 144 payment localities. Missing data does not establish a $0 allowance.

No national PFS rate in Q4 2026

Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

Check for a published amount in your locality.

Service-location ZIP

View contractor sources and effective dates

Amount evidence: MAC-published fee schedules and effective dates. The PFS row shows this code is priced by the contractor.

Inspect PFS status evidence

Code: 0627T
Release: Q4 2026, revision 2
Result: Contractor-priced

Citations

Shows this code’s PFS status (C). Result: Contractor-priced.

Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

PPRRVU2026_Oct_nonQPP.csv row 572 in rvu26d-updated-08-26-2026.zip

In the CMS file

Loading rows 570–574 of PPRRVU2026_Oct_nonQPP.csv…

Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

Plain-text summary Report a problem

CPT 0627T carries status C (carrier-priced) in the Q4 2026 release, so there is no single national rate—Medicare contractors publish their own amounts. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Contractor-published amounts on file range $241.03–$314.19 across 28 localities; enter a ZIP for the exact local amount.

Why is there no national PFS amount for 0627T?

Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

Find the local Medicare amount for 0627T Copy link

Medicare sets this price locally

0627T has no single national Physician Fee Schedule amount. Use the ZIP, modifier, setting, and participation fields above to match it to a Medicare locality and the contractor amount we have on file.

Your practical estimate will appear here

We hold files from First_coast and Novitas across JH and JL and JN, most recently effective Jan 1, 2026. A missing locality means our contractor coverage is incomplete—not that Medicare pays $0.

This is the published amount for this code—not necessarily the entire visit or procedure. A hospital may bill a separate facility charge, and other services, drugs, or supplies can add to the total.

Contractor-published source figures, not a national rate. Par = participating-provider amount Non-par = nonparticipating-provider amount C = technical component capped at the OPPS amount # = facility-setting amount

View all 56 published fee rows

Jurisdiction / locality	Modifier	Note	Par	Non-par	Limiting charge	Effective	Source
JH · Arkansas, Area 13 CMS 07102-13	—	—	$241.03	$228.98	$263.33	Jan 1, 2026	Contractor file
JH · Arkansas, Area 13 CMS 07102-13	—	#	$82.94	$78.79	$90.61	Jan 1, 2026	Contractor file
JH · Colorado, Area 01 CMS 04112-01	—	—	$286.04	$271.74	$312.50	Jan 1, 2026	Contractor file
JH · Colorado, Area 01 CMS 04112-01	—	#	$90.22	$85.71	$98.57	Jan 1, 2026	Contractor file
JH · Louisiana, Area 01 CMS 07202-01	—	—	$261.68	$248.60	$285.89	Jan 1, 2026	Contractor file
JH · Louisiana, Area 01 CMS 07202-01	—	#	$88.49	$84.07	$96.68	Jan 1, 2026	Contractor file
JH · Louisiana, Area 99 CMS 07202-99	—	—	$248.97	$236.52	$272.00	Jan 1, 2026	Contractor file
JH · Louisiana, Area 99 CMS 07202-99	—	#	$86.10	$81.80	$94.07	Jan 1, 2026	Contractor file
JH · Mississippi, Area 00 CMS 07302-00	—	—	$242.72	$230.58	$265.17	Jan 1, 2026	Contractor file
JH · Mississippi, Area 00 CMS 07302-00	—	#	$84.26	$80.05	$92.06	Jan 1, 2026	Contractor file
JH · New Mexico, Area 05 CMS 04212-05	—	—	$257.03	$244.18	$280.81	Jan 1, 2026	Contractor file
JH · New Mexico, Area 05 CMS 04212-05	—	#	$88.27	$83.86	$96.44	Jan 1, 2026	Contractor file
JH · Oklahoma, Area 00 CMS 04312-00	—	—	$249.62	$237.14	$272.71	Jan 1, 2026	Contractor file
JH · Oklahoma, Area 00 CMS 04312-00	—	#	$85.27	$81.01	$93.16	Jan 1, 2026	Contractor file
JH · Texas, Area 09 CMS 04412-09	—	—	$270.56	$257.03	$295.58	Jan 1, 2026	Contractor file
JH · Texas, Area 09 CMS 04412-09	—	#	$88.18	$83.77	$96.34	Jan 1, 2026	Contractor file
JH · Texas, Area 11 CMS 04412-11	—	—	$272.11	$258.50	$297.28	Jan 1, 2026	Contractor file
JH · Texas, Area 11 CMS 04412-11	—	#	$88.80	$84.36	$97.01	Jan 1, 2026	Contractor file
JH · Texas, Area 15 CMS 04412-15	—	—	$271.25	$257.69	$296.34	Jan 1, 2026	Contractor file
JH · Texas, Area 15 CMS 04412-15	—	#	$88.50	$84.08	$96.69	Jan 1, 2026	Contractor file
JH · Texas, Area 18 CMS 04412-18	—	—	$274.36	$260.64	$299.74	Jan 1, 2026	Contractor file
JH · Texas, Area 18 CMS 04412-18	—	#	$91.61	$87.03	$100.08	Jan 1, 2026	Contractor file
JH · Texas, Area 20 CMS 04412-20	—	—	$254.03	$241.33	$277.53	Jan 1, 2026	Contractor file
JH · Texas, Area 20 CMS 04412-20	—	#	$86.55	$82.22	$94.55	Jan 1, 2026	Contractor file
JH · Texas, Area 28 CMS 04412-28	—	—	$270.09	$256.59	$295.08	Jan 1, 2026	Contractor file
JH · Texas, Area 28 CMS 04412-28	—	#	$88.63	$84.20	$96.83	Jan 1, 2026	Contractor file
JH · Texas, Area 31 CMS 04412-31	—	—	$284.80	$270.56	$311.14	Jan 1, 2026	Contractor file
JH · Texas, Area 31 CMS 04412-31	—	#	$90.08	$85.58	$98.42	Jan 1, 2026	Contractor file
JH · Texas, Area 99 CMS 04412-99	—	—	$262.02	$248.92	$286.26	Jan 1, 2026	Contractor file
JH · Texas, Area 99 CMS 04412-99	—	#	$87.37	$83.00	$95.45	Jan 1, 2026	Contractor file
JL · Delaware, Area 01 CMS 12102-01	—	—	$270.43	$256.91	$295.45	Jan 1, 2026	Contractor file
JL · Delaware, Area 01 CMS 12102-01	—	#	$88.60	$84.17	$96.80	Jan 1, 2026	Contractor file
JL · District of Columbia, Area 01 CMS 12202-01	—	—	$314.19	$298.48	$343.25	Jan 1, 2026	Contractor file
JL · District of Columbia, Area 01 CMS 12202-01	—	#	$97.40	$92.53	$106.41	Jan 1, 2026	Contractor file
JL · Maryland, Area 01 CMS 12302-01	—	—	$290.74	$276.20	$317.63	Jan 1, 2026	Contractor file
JL · Maryland, Area 01 CMS 12302-01	—	#	$93.27	$88.61	$101.90	Jan 1, 2026	Contractor file
JL · Maryland, Area 99 CMS 12302-99	—	—	$275.85	$262.06	$301.37	Jan 1, 2026	Contractor file
JL · Maryland, Area 99 CMS 12302-99	—	#	$89.60	$85.12	$97.89	Jan 1, 2026	Contractor file
JL · New Jersey, Area 01 CMS 12402-01	—	—	$310.71	$295.17	$339.45	Jan 1, 2026	Contractor file
JL · New Jersey, Area 01 CMS 12402-01	—	#	$97.22	$92.36	$106.21	Jan 1, 2026	Contractor file
JL · New Jersey, Area 99 CMS 12402-99	—	—	$295.33	$280.56	$322.64	Jan 1, 2026	Contractor file
JL · New Jersey, Area 99 CMS 12402-99	—	#	$94.36	$89.64	$103.09	Jan 1, 2026	Contractor file
JL · Pennsylvania, Area 01 CMS 12502-01	—	—	$283.93	$269.73	$310.19	Jan 1, 2026	Contractor file
JL · Pennsylvania, Area 01 CMS 12502-01	—	#	$92.35	$87.73	$100.89	Jan 1, 2026	Contractor file
JL · Pennsylvania, Area 99 CMS 12502-99	—	—	$255.79	$243.00	$279.45	Jan 1, 2026	Contractor file
JL · Pennsylvania, Area 99 CMS 12502-99	—	#	$86.84	$82.50	$94.88	Jan 1, 2026	Contractor file
JN · Florida, Area 03 CMS 09102-03	—	—	$280.52	$266.49	$306.46	Jan 1, 2026	Contractor file
JN · Florida, Area 03 CMS 09102-03	—	#	$94.09	$89.39	$102.80	Jan 1, 2026	Contractor file
JN · Florida, Area 04 CMS 09102-04	—	—	$290.46	$275.94	$317.33	Jan 1, 2026	Contractor file
JN · Florida, Area 04 CMS 09102-04	—	#	$98.88	$93.94	$108.03	Jan 1, 2026	Contractor file
JN · Florida, Area 99 CMS 09102-99	—	—	$266.89	$253.55	$291.58	Jan 1, 2026	Contractor file
JN · Florida, Area 99 CMS 09102-99	—	#	$90.95	$86.40	$99.36	Jan 1, 2026	Contractor file
JN · Puerto Rico, Area 20 CMS 09202-20	—	—	$275.43	$261.66	$300.91	Jan 1, 2026	Contractor file
JN · Puerto Rico, Area 20 CMS 09202-20	—	#	$89.37	$84.90	$97.64	Jan 1, 2026	Contractor file
JN · U.S. Virgin Islands, Area 50 CMS 09202-50	—	—	$275.43	$261.66	$300.91	Jan 1, 2026	Contractor file
JN · U.S. Virgin Islands, Area 50 CMS 09202-50	—	#	$89.37	$84.90	$97.64	Jan 1, 2026	Contractor file

The authenticated MAC fees API returns the same source rows. ZIP5s that span localities are flagged and use only the crosswalk's dominant locality until ZIP+4 overrides are available.

Payment considerations Copy link

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

Bilateral adjustment Applies Multiple-procedure reduction Context required Global surgery Context required NCCI same-day edits Applies MUE behavior Applies Contractor pricing Applies

Other payment indicators (4)

Facility/non-facility: Not determined, Professional/technical component: Does not apply, Assistant/co-surgeon treatment: Does not apply, Other fee-schedule routing: Does not apply.

Why would a Medicare claim for 0627T 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
109 codes form NCCI pairs with 0627T carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
154 codes pair with 0627T under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
More than 1 unit per patient per date of service exceeds 0627T's Medically Unlikely Edit (MUE) limit. See billing together
Assistant at surgery: restricted without documentation. See billing policy
Co-surgeons: not permitted. See billing policy
Team surgery: not permitted. See billing policy
Multiple procedures: standard reduction applies. 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.

Which billing rules and modifiers apply? Copy link

Global period: what 0627T's fee already covers Copy link

YYY Contractor decides

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.

Billing policy Copy link

These billing-policy indicators explain how 0627T is treated. They apply whether the code is nationally priced or carrier-priced: 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.
Assistant at surgery	0	Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity.
Co-surgeons	0	Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure.
Team surgery	0	Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure.
Multiple procedures	2	Standard reduction applies. When billed with other procedures on the same date, the highest-valued one is paid at 100% and the next four at 50% each.
Professional/technical split	0	No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service.

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.

See every current NCCI pair for 0627T →

Billing together (NCCI edits) Copy link

NCCI Q4 2026

Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.

Not separately payable with 0627T on the same date of service—no modifier bypasses the edit (modifier indicator 0)

01937 01937 denies

01938 01938 denies

01939 01939 denies

Showing 3 of 109.

Separately payable with 0627T only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

0708T 0708T denies

0709T 0709T denies

0903T 0903T denies

Showing 3 of 154.

Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.

Check a paired code or view all 263 NCCI pairs →

Medically Unlikely Edit (MUE) limit: 1 unit per patient per date of service.

Reconciling a contractor-priced payment for 0627T Copy link

There is no national allowed amount for 0627T, 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.
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.
Rank the claim’s procedure lines before calling a reduced line short-paid—under the standard multiple-procedure rule only the highest-valued one prices in full.
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.

Check an actual payment Model this code in a contract

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.

Did this answer your question about CPT 0627T?

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Source & method

Show sources

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.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 572)

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

CPT 0627T National PFS baseline: No national PFS rate (Q4 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26D, PPRRVU2026_Oct_nonQPP.csv row 572. Localis. https://localishealth.com/cpt/0627T/2026/D