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CPT 0826T Medicare carrier-priced amounts

Contractor-priced

0826T · PFS Q3 2024 · Historical

Contractor-published range

$60.12–$69.25

Participating · Office (non-facility) · Whole service

MAC-published fee schedules available in Localis: 15 of 144 payment localities. Missing data does not establish a $0 allowance.

No national PFS rate in Q3 2024

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
0826T
Release
Q3 2024, revision 1
Result
Contractor-priced

Citations

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

    Physician relative value file (PPRRVU)CMS RVU24CJuly 1 – September 30, 2024

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

    PPRRVU24_JUL.csv row 6,735 in rvu24c-updated-09-09-2024.zip

    In the CMS file

    Loading rows 6,733–6,737 of PPRRVU24_JUL.csv…

    Download rvu24c-updated-09-09-2024.zip from CMS File fingerprint 63e2b9617ccd91e8ad68d5f23a0ae26a106d0cdfdf6390631fbac7b7e0513df1

Report a problem

CPT 0826T carries status C (carrier-priced) in the Q3 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 $60.12–$69.25 across 15 localities; enter a ZIP for the exact local amount.

Why is there no national PFS amount for 0826T?

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 0826T Copy link

Medicare sets this price locally

0826T 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 Novitas across JH, most recently effective Mar 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.

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 45 published fee rows
Jurisdiction / locality Modifier Note Par Non-par Limiting charge Effective Source
JH · Arkansas, Area 13 CMS 07102-13 — — $60.23 $57.22 $65.80 Mar 1, 2024 Contractor file
JH · Arkansas, Area 13 CMS 07102-13 -26 — $28.85 $27.41 $31.52 Mar 1, 2024 Contractor file
JH · Arkansas, Area 13 CMS 07102-13 -TC — $31.38 $29.81 $34.28 Mar 1, 2024 Contractor file
JH · Colorado, Area 01 CMS 04112-01 — — $69.25 $65.79 $75.66 Mar 1, 2024 Contractor file
JH · Colorado, Area 01 CMS 04112-01 -26 — $30.77 $29.23 $33.61 Mar 1, 2024 Contractor file
JH · Colorado, Area 01 CMS 04112-01 -TC — $38.48 $36.56 $42.04 Mar 1, 2024 Contractor file
JH · Louisiana, Area 01 CMS 07202-01 — — $64.19 $60.98 $70.13 Mar 1, 2024 Contractor file
JH · Louisiana, Area 01 CMS 07202-01 -26 — $29.88 $28.39 $32.65 Mar 1, 2024 Contractor file
JH · Louisiana, Area 01 CMS 07202-01 -TC — $34.31 $32.59 $37.48 Mar 1, 2024 Contractor file
JH · Louisiana, Area 99 CMS 07202-99 — — $61.62 $58.54 $67.32 Mar 1, 2024 Contractor file
JH · Louisiana, Area 99 CMS 07202-99 -26 — $29.33 $27.86 $32.04 Mar 1, 2024 Contractor file
JH · Louisiana, Area 99 CMS 07202-99 -TC — $32.29 $30.68 $35.28 Mar 1, 2024 Contractor file
JH · Mississippi, Area 00 CMS 07302-00 — — $60.12 $57.11 $65.68 Mar 1, 2024 Contractor file
JH · Mississippi, Area 00 CMS 07302-00 -26 — $28.95 $27.50 $31.63 Mar 1, 2024 Contractor file
JH · Mississippi, Area 00 CMS 07302-00 -TC — $31.17 $29.61 $34.05 Mar 1, 2024 Contractor file
JH · New Mexico, Area 05 CMS 04212-05 — — $63.01 $59.86 $68.84 Mar 1, 2024 Contractor file
JH · New Mexico, Area 05 CMS 04212-05 -26 — $29.67 $28.19 $32.42 Mar 1, 2024 Contractor file
JH · New Mexico, Area 05 CMS 04212-05 -TC — $33.34 $31.67 $36.42 Mar 1, 2024 Contractor file
JH · Oklahoma, Area 00 CMS 04312-00 — — $61.90 $58.81 $67.63 Mar 1, 2024 Contractor file
JH · Oklahoma, Area 00 CMS 04312-00 -26 — $29.30 $27.84 $32.02 Mar 1, 2024 Contractor file
JH · Oklahoma, Area 00 CMS 04312-00 -TC — $32.60 $30.97 $35.62 Mar 1, 2024 Contractor file
JH · Texas, Area 09 CMS 04412-09 — — $67.27 $63.91 $73.50 Mar 1, 2024 Contractor file
JH · Texas, Area 09 CMS 04412-09 -26 — $30.51 $28.98 $33.33 Mar 1, 2024 Contractor file
JH · Texas, Area 09 CMS 04412-09 -TC — $36.77 $34.93 $40.17 Mar 1, 2024 Contractor file
JH · Texas, Area 11 CMS 04412-11 — — $67.33 $63.96 $73.55 Mar 1, 2024 Contractor file
JH · Texas, Area 11 CMS 04412-11 -26 — $30.50 $28.98 $33.33 Mar 1, 2024 Contractor file
JH · Texas, Area 11 CMS 04412-11 -TC — $36.83 $34.99 $40.24 Mar 1, 2024 Contractor file
JH · Texas, Area 15 CMS 04412-15 — — $67.07 $63.72 $73.28 Mar 1, 2024 Contractor file
JH · Texas, Area 15 CMS 04412-15 -26 — $30.50 $28.98 $33.33 Mar 1, 2024 Contractor file
JH · Texas, Area 15 CMS 04412-15 -TC — $36.57 $34.74 $39.95 Mar 1, 2024 Contractor file
JH · Texas, Area 18 CMS 04412-18 — — $67.75 $64.36 $74.01 Mar 1, 2024 Contractor file
JH · Texas, Area 18 CMS 04412-18 -26 — $30.89 $29.35 $33.75 Mar 1, 2024 Contractor file
JH · Texas, Area 18 CMS 04412-18 -TC — $36.86 $35.02 $40.27 Mar 1, 2024 Contractor file
JH · Texas, Area 20 CMS 04412-20 — — $62.56 $59.43 $68.34 Mar 1, 2024 Contractor file
JH · Texas, Area 20 CMS 04412-20 -26 — $29.48 $28.01 $32.21 Mar 1, 2024 Contractor file
JH · Texas, Area 20 CMS 04412-20 -TC — $33.08 $31.43 $36.14 Mar 1, 2024 Contractor file
JH · Texas, Area 28 CMS 04412-28 — — $66.96 $63.61 $73.15 Mar 1, 2024 Contractor file
JH · Texas, Area 28 CMS 04412-28 -26 — $30.45 $28.93 $33.27 Mar 1, 2024 Contractor file
JH · Texas, Area 28 CMS 04412-28 -TC — $36.51 $34.68 $39.88 Mar 1, 2024 Contractor file
JH · Texas, Area 31 CMS 04412-31 — — $68.86 $65.42 $75.23 Mar 1, 2024 Contractor file
JH · Texas, Area 31 CMS 04412-31 -26 — $30.60 $29.07 $33.43 Mar 1, 2024 Contractor file
JH · Texas, Area 31 CMS 04412-31 -TC — $38.26 $36.35 $41.80 Mar 1, 2024 Contractor file
JH · Texas, Area 99 CMS 04412-99 — — $64.41 $61.19 $70.37 Mar 1, 2024 Contractor file
JH · Texas, Area 99 CMS 04412-99 -26 — $29.81 $28.32 $32.57 Mar 1, 2024 Contractor file
JH · Texas, Area 99 CMS 04412-99 -TC — $34.60 $32.87 $37.80 Mar 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.

Which billing rules and modifiers apply? Copy link

CMS indicators that apply to 0826T: PCTC 1 (splits into professional and technical) · MULT PROC 6 (cardiovascular reduction applies).

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.

Multiple procedures

Cardiovascular reduction applies

MULT PROC

6

The technical component of the second and subsequent ranked diagnostic cardiovascular procedure on the same day is reduced; the professional component is never reduced.

-51 depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one.

Global surgery period XXX (does not apply).

Why would a Medicare claim for 0826T 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
  • 0826T 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 RVU24CJuly 1 – September 30, 2024

Can you bill it with another code? Copy link

This code

0826T

See every current NCCI pair for 0826T →

Reconciling a contractor-priced payment for 0826T Copy link

Checking a paid 0826T line?

Check an actual payment Model this code in a contract
What to check (5)

There is no national allowed amount for 0826T, 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 a second cardiovascular diagnostic line on the same date: the lower-ranked technical component is reduced by rule, while the professional component is never reduced.
  • 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); CMS Transmittal R1149OTN: MPPR on the Technical Component of Diagnostic Cardiovascular and Ophthalmology Procedures.

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 PPRRVU24_JUL.csv · Q3 2024 (RVU24C) · row 6,735—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q3 2024 release
    Effective
    July 1 – September 30, 2024
    Locator
    PPRRVU24_JUL.csv in rvu24c-updated-09-09-2024.zip · row 6,735 of 18,664 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 63e2b9617ccd91e8…
  2. 02 MAC-published fee schedules · 15 on file—the contractor amounts
    Source
    MAC-published fee schedules
    Effective
    Effective dates shown above

Cite this rate

CPT 0826T National PFS baseline: No national PFS rate (Q3 2024; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU24C, PPRRVU24_JUL.csv row 6,735. Localis. https://localishealth.com/cpt/0826T/2024/C

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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