CPT 0691T
No national payment amount
Carrier-priced: no national payment amount.
Does Medicare pay separately for CPT 0691T in 2026?
Not at a published national rate. CPT 0691T carries status C (carrier-priced) in the Q3 2026 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Treat the blank amount as unpriced, not as $0.
Common questions
Why is there no payment amount for 0691T?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.
Why would a Medicare claim for 0691T be denied or paid less?
Each item below comes from a CMS indicator 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
- 46 codes can never be billed with 0691T on the same date of service — NCCI denies those pairs even with a modifier. See billing together
- 2 codes pair with 0691T only when modifier 59 (or XE, XS, XP, XU) documents a distinct service — billed together without one, a line of the pair denies. See billing together
- 0691T 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
- Bilateral surgery: no bilateral adjustment. 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.
Saw this code on your bill?
What is a 0691T visit in patient-friendly terms?
We haven't written the plain-language description for CPT 0691T yet — ask your provider's billing office what service it covers in the meantime.
How this amount is computed
amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.
| Component | RVU |
|---|---|
| Work RVU | blank |
| Practice expense RVU (non-facility) | blank |
| Practice expense RVU (facility) | blank |
| Malpractice RVU | blank |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.
Billing policy
What 0691T'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 | 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. |
Rate history by release
National non-facility amount for 0691T across quarterly releases.
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q3 2026 Jun 30, 2026 – present | C | — | — |
| Q2 2026 Mar 10, 2026 – Jun 29, 2026 | C | — | — |
| Q1 2026 Dec 29, 2025 – Mar 9, 2026 | C | — | — |
| Q4 2025 Sep 11, 2025 – Dec 28, 2025 | C | — | — |
| Q3 2025 Jun 5, 2025 – Sep 10, 2025 | C | — | — |
| Q2 2025 Jun 5, 2025 – Jun 4, 2025 | C | — | — |
| Q1 2025 Dec 23, 2024 – Jun 4, 2025 | C | — | — |
Billing together (NCCI edits)
NCCI Q3 2026Based on CMS's National Correct Coding Initiative (NCCI) — hover a code to see how it's used.
Never billable with 0691T on the same date of service
Showing 3 of 46 — search above to check a specific code.
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Source & method
This is computed from CMS's Medicare Physician Fee Schedule Q3 2026 release (schedule pfs, effective July 2026). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. Commercial and cash-pay figures anywhere on this page are arithmetic on the Medicare amount, using commonly cited reimbursement ranges. They're illustrative, and no nationwide claims database stands behind them.
Conversion factor $33.4009 read from the same file, row 11, column 26.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This link keeps pointing at the Q3 2026 figures, even after a newer release lands.
CPT 0691T Medicare Physician Fee Schedule rate (Q3 2026). Localis. https://localishealth.com/cpt/0691T/2026/C