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Q4 2026 takes effect Oct 1, 2026. CMS published it early; dates of service before then are priced under the current release — see the current CPT 0629T rate.

CPT 0629T

Contractor-priced

0629T · PFS Q4 2026 · Upcoming

Contractor-published range

$241.03–$290.46

Participating · Office (non-facility) · Whole service

MAC-published fee schedules available in Localis: 20 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.

View contractor sources and effective dates

CMS published status C (carrier-priced) for CPT 0629T in the Q4 2026 Physician Fee Schedule, with no national PFS amount. These figures take effect for dates of service beginning Oct 1, 2026. Treat the blank amount as unpriced, not as $0.

Amount evidence: MAC-published fee schedules and effective dates. The PFS row establishes contractor pricing.

Inspect PFS status evidence
Code
0629T
Release
Q4 2026, revision 2
Result
Contractor-priced

Citations

  • Establishes the PFS status (C) and the resulting pathway for this code: contractor-priced.

    Physician relative value file (PPRRVU)

    Q4 2026 · revision 2

    Latest revision of this release

    Release period: October 1 – December 31, 2026

    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 PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 574)
    hcpcs (col 1)
    0629T
    modifier (col 2)
    blank
    status_code (col 4)
    C

    SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

    Original source file

Compact facts

Why is there no national PFS amount for 0629T?

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.

Bilateral adjustment Applies Multiple-procedure reduction Context required Global surgery Context required NCCI same-day edits Applies Contractor pricing Applies
Other payment indicators (5)

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

Find the local Medicare amount for 0629T Copy link

Medicare sets this price locally

0629T 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 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 40 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
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.

Reconciling a contractor-priced payment for 0629T Copy link

There is no national allowed amount for 0629T, 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.
  • 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.

Nearby payment lines

National Q4 2026 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.

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).

Payment rules

Global period: what 0629T'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

What 0629T'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.
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. The same standard ranking-and-reduction rule as indicator 1 applies to this procedure when billed with others on the same date.
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

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 0629T.

See every current NCCI pair for 0629T →

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 0629T 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 0629T 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 155.

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 264 NCCI pairs →

Common payment questions Copy link

Why would a Medicare claim for 0629T 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 0629T 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
  • 155 codes pair with 0629T 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
  • 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.

History
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

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.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 574)

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 0629T National PFS baseline: No national PFS rate (Q4 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/0629T/2026/D