CPT 0637T
Contractor-priced
0637T · PFS Q1 2024 · Historical
Contractor-published range
$174.34–$205.87
Participating · Office (non-facility) · Whole service
MAC-published fee schedules available in Localis: 18 of 144 payment localities. Missing data does not establish a $0 allowance.
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.
CPT 0637T carries status C (carrier-priced) in the Q1 2024 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 $174.34–$205.87 across 18 localities; enter a ZIP for the exact local amount.
Amount evidence: MAC-published fee schedules and effective dates. The PFS row establishes contractor pricing.
Inspect PFS status evidence
- Code
- 0637T
- Release
- Q1 2024, 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)Q1 2024 · revision 1
Superseded revision
Release period: January 1 – March 8, 2024
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
PPRRVU24_JAN.csv in rvu24a-updated-04-01-2024.zip (row 6,386)- hcpcs (col 1)
- 0637T
- modifier (col 2)
- blank
- status_code (col 4)
- C
SHA-256: 034f3aa88a63e6f7ca3859c09b3945dce139171a6fc5a710300fc7b815e9b65b
Why is there no national PFS amount for 0637T?
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.
Find the local Medicare amount for 0637T Copy link
Medicare sets this price locally
0637T 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, 2024. 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.
View all 54 published fee rows
| Jurisdiction / locality | Modifier | Note | Par | Non-par | Limiting charge | Effective | Source |
|---|---|---|---|---|---|---|---|
| JH · Arkansas, Area 13 CMS 07102-13 | — | — | $174.92 | $166.17 | $191.10 | Jan 1, 2024 | Contractor file |
| JH · Arkansas, Area 13 CMS 07102-13 | -26 | — | $54.34 | $51.62 | $59.36 | Jan 1, 2024 | Contractor file |
| JH · Arkansas, Area 13 CMS 07102-13 | -TC | — | $120.58 | $114.55 | $131.73 | Jan 1, 2024 | Contractor file |
| JH · Colorado, Area 01 CMS 04112-01 | — | — | $205.82 | $195.53 | $224.86 | Jan 1, 2024 | Contractor file |
| JH · Colorado, Area 01 CMS 04112-01 | -26 | — | $58.05 | $55.15 | $63.42 | Jan 1, 2024 | Contractor file |
| JH · Colorado, Area 01 CMS 04112-01 | -TC | — | $147.77 | $140.38 | $161.44 | Jan 1, 2024 | Contractor file |
| JH · Louisiana, Area 01 CMS 07202-01 | — | — | $188.16 | $178.75 | $205.56 | Jan 1, 2024 | Contractor file |
| JH · Louisiana, Area 01 CMS 07202-01 | -26 | — | $56.67 | $53.84 | $61.92 | Jan 1, 2024 | Contractor file |
| JH · Louisiana, Area 01 CMS 07202-01 | -TC | — | $131.49 | $124.92 | $143.66 | Jan 1, 2024 | Contractor file |
| JH · Louisiana, Area 99 CMS 07202-99 | — | — | $179.38 | $170.41 | $195.97 | Jan 1, 2024 | Contractor file |
| JH · Louisiana, Area 99 CMS 07202-99 | -26 | — | $55.55 | $52.77 | $60.69 | Jan 1, 2024 | Contractor file |
| JH · Louisiana, Area 99 CMS 07202-99 | -TC | — | $123.82 | $117.63 | $135.27 | Jan 1, 2024 | Contractor file |
| JH · Mississippi, Area 00 CMS 07302-00 | — | — | $174.34 | $165.62 | $190.46 | Jan 1, 2024 | Contractor file |
| JH · Mississippi, Area 00 CMS 07302-00 | -26 | — | $54.71 | $51.97 | $59.77 | Jan 1, 2024 | Contractor file |
| JH · Mississippi, Area 00 CMS 07302-00 | -TC | — | $119.63 | $113.65 | $130.70 | Jan 1, 2024 | Contractor file |
| JH · New Mexico, Area 05 CMS 04212-05 | — | — | $184.04 | $174.84 | $201.07 | Jan 1, 2024 | Contractor file |
| JH · New Mexico, Area 05 CMS 04212-05 | -26 | — | $56.31 | $53.49 | $61.51 | Jan 1, 2024 | Contractor file |
| JH · New Mexico, Area 05 CMS 04212-05 | -TC | — | $127.72 | $121.33 | $139.53 | Jan 1, 2024 | Contractor file |
| JH · Oklahoma, Area 00 CMS 04312-00 | — | — | $180.47 | $171.45 | $197.17 | Jan 1, 2024 | Contractor file |
| JH · Oklahoma, Area 00 CMS 04312-00 | -26 | — | $55.36 | $52.59 | $60.48 | Jan 1, 2024 | Contractor file |
| JH · Oklahoma, Area 00 CMS 04312-00 | -TC | — | $125.11 | $118.85 | $136.68 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 09 CMS 04412-09 | — | — | $198.74 | $188.80 | $217.12 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 09 CMS 04412-09 | -26 | — | $57.56 | $54.68 | $62.88 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 09 CMS 04412-09 | -TC | — | $141.18 | $134.12 | $154.24 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 11 CMS 04412-11 | — | — | $198.98 | $189.03 | $217.38 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 11 CMS 04412-11 | -26 | — | $57.61 | $54.73 | $62.94 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 11 CMS 04412-11 | -TC | — | $141.37 | $134.30 | $154.45 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 15 CMS 04412-15 | — | — | $197.97 | $188.07 | $216.28 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 15 CMS 04412-15 | -26 | — | $57.59 | $54.71 | $62.92 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 15 CMS 04412-15 | -TC | — | $140.38 | $133.36 | $153.36 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 18 CMS 04412-18 | — | — | $199.88 | $189.89 | $218.37 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 18 CMS 04412-18 | -26 | — | $58.72 | $55.78 | $64.15 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 18 CMS 04412-18 | -TC | — | $141.16 | $134.10 | $154.22 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 20 CMS 04412-20 | — | — | $182.68 | $173.55 | $199.58 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 20 CMS 04412-20 | -26 | — | $55.80 | $53.01 | $60.96 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 20 CMS 04412-20 | -TC | — | $126.88 | $120.54 | $138.62 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 28 CMS 04412-28 | — | — | $197.66 | $187.78 | $215.95 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 28 CMS 04412-28 | -26 | — | $57.53 | $54.65 | $62.85 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 28 CMS 04412-28 | -TC | — | $140.13 | $133.12 | $153.09 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 31 CMS 04412-31 | — | — | $204.64 | $194.41 | $223.57 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 31 CMS 04412-31 | -26 | — | $57.80 | $54.91 | $63.15 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 31 CMS 04412-31 | -TC | — | $146.85 | $139.51 | $160.44 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 99 CMS 04412-99 | — | — | $189.12 | $179.66 | $206.61 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 99 CMS 04412-99 | -26 | — | $56.38 | $53.56 | $61.59 | Jan 1, 2024 | Contractor file |
| JH · Texas, Area 99 CMS 04412-99 | -TC | — | $132.74 | $126.10 | $145.02 | Jan 1, 2024 | Contractor file |
| JN · Florida, Area 03 CMS 09102-03 | — | — | $199.48 | $189.51 | $217.94 | Jan 1, 2024 | Contractor file |
| JN · Florida, Area 03 CMS 09102-03 | -26 | — | $58.79 | $55.85 | $64.23 | Jan 1, 2024 | Contractor file |
| JN · Florida, Area 03 CMS 09102-03 | -TC | — | $140.70 | $133.67 | $153.72 | Jan 1, 2024 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | — | — | $205.87 | $195.58 | $224.92 | Jan 1, 2024 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | -26 | — | $60.64 | $57.61 | $66.25 | Jan 1, 2024 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | -TC | — | $145.23 | $137.97 | $158.67 | Jan 1, 2024 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | — | — | $189.74 | $180.25 | $207.29 | Jan 1, 2024 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | -26 | — | $57.36 | $54.49 | $62.66 | Jan 1, 2024 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | -TC | — | $132.39 | $125.77 | $144.64 | Jan 1, 2024 | 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 0637T Copy link
There is no national allowed amount for 0637T, 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.
- Confirm both sides were priced at 100%: this procedure takes no bilateral adjustment, though anything else billed the same day may still rank under the multiple-procedure rule.
- Check for documentation on file before appealing an assistant-at-surgery denial: payment on the -80 or -AS line is restricted for this procedure unless medical necessity is established.
- 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 Q1 2024 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); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
Global period: what 0637T's fee already covers Copy link
The global surgery concept does not apply to this code.
Billing policy Copy link
What 0637T'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 | 3 | Both sides paid at 100%. No special bilateral adjustment applies here—each side is paid at 100% of the fee schedule amount, subject to the usual multiple-procedure rules for other services billed the same day. |
| 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 | 0 | No reduction. No payment reduction applies when this procedure is billed with other procedures on the same date—each is treated as unrelated. |
| 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 0637T.
Common payment questions Copy link
Why would a Medicare claim for 0637T 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
- 0637T 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
- Assistant at surgery: restricted without documentation. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. 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.
Did this answer your question about CPT 0637T?
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 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 0637T National PFS baseline: No national PFS rate (Q1 2024; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/0637T/2024/A/1