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CPT 0643T

Contractor-priced

0643T · PFS Q2 2026 · Historical

Contractor-published range

$1,179.54–$1,651.82

Participating · Office (non-facility) · Whole service

MAC-published fee schedules available in Localis: 43 of 144 payment localities. Missing data does not establish a $0 allowance.

No national PFS rate in Q2 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

CPT 0643T carries status C (carrier-priced) in the Q2 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 $1,179.54–$1,651.82 across 43 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
0643T
Release
Q2 2026, 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 2026 · revision 1

    Latest revision of this release

    Release period: April 1 – June 30, 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_Apr_nonQPP.csv in rvu26b-updated-05-01-2026.zip (row 599)
    hcpcs (col 1)
    0643T
    modifier (col 2)
    blank
    status_code (col 4)
    C

    SHA-256: afc9cf9fe60742518cf6aaccd507edc035052ab9ab1be48644be39f38fceec48

    Original source file

Compact facts

Why is there no national PFS amount for 0643T?

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.

Multiple-procedure reduction Context required Global surgery Context required Contractor pricing Applies
Other payment indicators (7)

Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Assistant/co-surgeon treatment: 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 0643T Copy link

Medicare sets this price locally

0643T 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 Noridian across JE and JF, 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 43 published fee rows
Jurisdiction / locality Modifier Note Par Non-par Limiting charge Effective Source
JE · California, Area 05 CMS 01112-05 — — $1,402.19 $1,332.08 $1,531.89 Jan 1, 2026 Contractor file
JE · California, Area 09 CMS 01112-09 — — $1,420.75 $1,349.71 $1,552.17 Jan 1, 2026 Contractor file
JE · California, Area 17 CMS 01182-17 — — $1,303.09 $1,237.94 $1,423.63 Jan 1, 2026 Contractor file
JE · California, Area 18 CMS 01182-18 — — $1,319.74 $1,253.75 $1,441.81 Jan 1, 2026 Contractor file
JE · California, Area 51 CMS 01112-51 — — $1,358.47 $1,290.55 $1,484.13 Jan 1, 2026 Contractor file
JE · California, Area 52 CMS 01112-52 — — $1,406.75 $1,336.41 $1,536.87 Jan 1, 2026 Contractor file
JE · California, Area 53 CMS 01112-53 — — $1,351.91 $1,284.31 $1,476.96 Jan 1, 2026 Contractor file
JE · California, Area 54 CMS 01112-54 — — $1,267.41 $1,204.04 $1,384.65 Jan 1, 2026 Contractor file
JE · California, Area 55 CMS 01112-55 — — $1,255.97 $1,193.17 $1,372.15 Jan 1, 2026 Contractor file
JE · California, Area 56 CMS 01112-56 — — $1,255.97 $1,193.17 $1,372.15 Jan 1, 2026 Contractor file
JE · California, Area 57 CMS 01112-57 — — $1,255.97 $1,193.17 $1,372.15 Jan 1, 2026 Contractor file
JE · California, Area 58 CMS 01112-58 — — $1,255.97 $1,193.17 $1,372.15 Jan 1, 2026 Contractor file
JE · California, Area 59 CMS 01112-59 — — $1,255.97 $1,193.17 $1,372.15 Jan 1, 2026 Contractor file
JE · California, Area 60 CMS 01112-60 — — $1,255.97 $1,193.17 $1,372.15 Jan 1, 2026 Contractor file
JE · California, Area 61 CMS 01112-61 — — $1,255.97 $1,193.17 $1,372.15 Jan 1, 2026 Contractor file
JE · California, Area 62 CMS 01112-62 — — $1,299.26 $1,234.30 $1,419.45 Jan 1, 2026 Contractor file
JE · California, Area 63 CMS 01112-63 — — $1,292.31 $1,227.69 $1,411.84 Jan 1, 2026 Contractor file
JE · California, Area 64 CMS 01112-64 — — $1,286.91 $1,222.56 $1,405.94 Jan 1, 2026 Contractor file
JE · California, Area 65 CMS 01112-65 — — $1,439.37 $1,367.40 $1,572.51 Jan 1, 2026 Contractor file
JE · California, Area 66 CMS 01112-66 — — $1,295.67 $1,230.89 $1,415.52 Jan 1, 2026 Contractor file
JE · California, Area 67 CMS 01112-67 — — $1,307.16 $1,241.80 $1,428.07 Jan 1, 2026 Contractor file
JE · California, Area 68 CMS 01112-68 — — $1,255.97 $1,193.17 $1,372.15 Jan 1, 2026 Contractor file
JE · California, Area 69 CMS 01112-69 — — $1,255.97 $1,193.17 $1,372.15 Jan 1, 2026 Contractor file
JE · California, Area 70 CMS 01112-70 — — $1,255.97 $1,193.17 $1,372.15 Jan 1, 2026 Contractor file
JE · California, Area 71 CMS 01182-71 — — $1,256.64 $1,193.81 $1,372.88 Jan 1, 2026 Contractor file
JE · California, Area 72 CMS 01182-72 — — $1,298.19 $1,233.28 $1,418.27 Jan 1, 2026 Contractor file
JE · California, Area 73 CMS 01182-73 — — $1,269.11 $1,205.65 $1,386.50 Jan 1, 2026 Contractor file
JE · California, Area 74 CMS 01182-74 — — $1,286.54 $1,222.21 $1,405.54 Jan 1, 2026 Contractor file
JE · California, Area 75 CMS 01112-75 — — $1,255.97 $1,193.17 $1,372.15 Jan 1, 2026 Contractor file
JE · Hawaii, Area 01 CMS 01212-01 — — $1,260.06 $1,197.06 $1,376.62 Jan 1, 2026 Contractor file
JE · Nevada, Area 00 CMS 01312-00 — — $1,252.52 $1,189.89 $1,368.37 Jan 1, 2026 Contractor file
JF · Alaska, Area 01 CMS 02102-01 — — $1,651.82 $1,569.23 $1,804.61 Jan 1, 2026 Contractor file
JF · Arizona, Area 00 CMS 03102-00 — — $1,245.82 $1,183.53 $1,361.06 Jan 1, 2026 Contractor file
JF · Idaho, Area 00 CMS 02202-00 — — $1,179.54 $1,120.56 $1,288.64 Jan 1, 2026 Contractor file
JF · Montana, Area 01 CMS 03202-01 — — $1,274.31 $1,210.59 $1,392.18 Jan 1, 2026 Contractor file
JF · North Dakota, Area 01 CMS 03302-01 — — $1,195.02 $1,135.27 $1,305.56 Jan 1, 2026 Contractor file
JF · Oregon, Area 01 CMS 02302-01 — — $1,287.57 $1,223.19 $1,406.67 Jan 1, 2026 Contractor file
JF · Oregon, Area 99 CMS 02302-99 — — $1,233.58 $1,171.90 $1,347.69 Jan 1, 2026 Contractor file
JF · South Dakota, Area 02 CMS 03402-02 — — $1,185.64 $1,126.36 $1,295.31 Jan 1, 2026 Contractor file
JF · Utah, Area 09 CMS 03502-09 — — $1,242.58 $1,180.45 $1,357.52 Jan 1, 2026 Contractor file
JF · Washington, Area 02 CMS 02402-02 — — $1,361.19 $1,293.13 $1,487.10 Jan 1, 2026 Contractor file
JF · Washington, Area 99 CMS 02402-99 — — $1,269.62 $1,206.14 $1,387.06 Jan 1, 2026 Contractor file
JF · Wyoming, Area 21 CMS 03602-21 — — $1,239.75 $1,177.76 $1,354.42 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 0643T Copy link

There is no national allowed amount for 0643T, 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 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 Q2 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); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

Payment rules

Global period: what 0643T'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 0643T'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 0 No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure.
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 0643T.

See every current NCCI pair for 0643T →

Common payment questions Copy link

Why would a Medicare claim for 0643T be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

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 (Q2 2026) · rvu26b-updated-05-01-2026.zip (PPRRVU2026_Apr_nonQPP.csv row 599)

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 0643T National PFS baseline: No national PFS rate (Q2 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/0643T/2026/B