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CPT 0691T Medicare carrier-priced amounts

Contractor-priced

0691T · PFS Q1 2022 · Historical

Contractor-published range

$8.53–$9.33

Participating · Office (non-facility) · Whole service

MAC-published fee schedules available in Localis: 3 of 144 payment localities. Missing data does not establish a $0 allowance.

No national PFS rate in Q1 2022

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

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
0691T
Release
Q1 2022, revision 1
Result
Contractor-priced

Citations

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

    Physician relative value file (PPRRVU)CMS RVU22AJanuary 1 – March 31, 2022

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

    PPRRVU22_JAN.csv row 5,838 in rvu22a.zip

    In the CMS file

    Loading rows 5,836–5,840 of PPRRVU22_JAN.csv…

    Download rvu22a.zip from CMS File fingerprint 10258dd1f6966657ef18c0f2c85ff446c9d799406974c4b536139a327c43799e

Report a problem

CPT 0691T carries status C (carrier-priced) in the Q1 2022 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 $8.53–$9.33 across 3 localities; enter a ZIP for the exact local amount.

Why is there no national PFS amount for 0691T?

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 0691T Copy link

Medicare sets this price locally

0691T 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 across JN, most recently effective Jan 1, 2022. 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 3 published fee rows
Jurisdiction / locality Modifier Note Par Non-par Limiting charge Effective Source
JN · Florida, Area 03 CMS 09102-03 — — $9.11 $8.65 $9.95 Jan 1, 2022 Contractor file
JN · Florida, Area 04 CMS 09102-04 — — $9.33 $8.86 $10.19 Jan 1, 2022 Contractor file
JN · Florida, Area 99 CMS 09102-99 — — $8.53 $8.10 $9.32 Jan 1, 2022 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.

Which billing rules and modifiers apply? Copy link

CMS indicators that apply to 0691T: PCTC 1 (splits into professional and technical).

Professional/technical split

Splits into professional and technical

PCTC

1

This procedure splits into a professional component (modifier 26) and a technical component (modifier TC), each separately payable.

Global surgery period XXX (does not apply).

Why would a Medicare claim for 0691T 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
  • 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.

CMS RVU22AJanuary 1 – March 31, 2022

Can you bill it with another code? Copy link

This code

0691T

See every current NCCI pair for 0691T →

Reconciling a contractor-priced payment for 0691T Copy link

Checking a paid 0691T line?

Check an actual payment Model this code in a contract
What to check (4)

There is no national allowed amount for 0691T, 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.

  • 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.
  • 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.

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.

Source & method Copy link

The PFS file shows this code is priced by the contractor. Its amounts come from the MAC-published schedules and effective dates shown above.

  1. 01 PPRRVU22_JAN.csv · Q1 2022 (RVU22A) · row 5,838—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q1 2022 release
    Effective
    January 1 – March 31, 2022
    Locator
    PPRRVU22_JAN.csv in rvu22a.zip · row 5,838 of 17,600 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 10258dd1f6966657…
  2. 02 MAC-published fee schedules · 3 on file—the contractor amounts
    Source
    MAC-published fee schedules
    Effective
    Effective dates shown above

Cite this rate

CPT 0691T National PFS baseline: No national PFS rate (Q1 2022; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU22A, PPRRVU22_JAN.csv row 5,838. Localis. https://localishealth.com/cpt/0691T/2022/A

Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. Methodology · Plain-text summary · JSON

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.

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