Contractor-priced
0869T · PFS Q4 2025 · Historical
Contractor-published range
$311.73–$374.32
Participating · Office (non-facility) · Whole service
MAC-published fee schedules available in Localis: 17 of 144 payment localities. Missing data does not establish a $0 allowance.
No national PFS rate in Q4 2025
Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Check for a published amount in your locality.
CPT 0869T carries status C (carrier-priced) in the Q4 2025 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 $311.73–$374.32 across 17 localities; enter a ZIP for the exact local amount.
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
- 0869T
- Release
- Q4 2025, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU25DOctober 1 – December 31, 2025
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU2025_Oct.csv row 902 in rvu25d-updated-09-11-2025.zip
In the CMS file
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Why is there no national PFS amount for 0869T?
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 0869T Copy link
Medicare sets this price locally
0869T 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, 2025. 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 34 published fee rows
| Jurisdiction / locality | Modifier | Note | Par | Non-par | Limiting charge | Effective | Source |
|---|---|---|---|---|---|---|---|
| JH · Arkansas, Area 13 CMS 07102-13 | — | — | $311.73 | $296.14 | $340.56 | Jan 1, 2025 | Contractor file |
| JH · Arkansas, Area 13 CMS 07102-13 | — | # | $238.84 | $226.90 | $260.94 | Jan 1, 2025 | Contractor file |
| JH · Colorado, Area 01 CMS 04112-01 | — | — | $363.65 | $345.47 | $397.29 | Jan 1, 2025 | Contractor file |
| JH · Colorado, Area 01 CMS 04112-01 | — | # | $274.41 | $260.69 | $299.79 | Jan 1, 2025 | Contractor file |
| JH · Louisiana, Area 01 CMS 07202-01 | — | — | $337.15 | $320.29 | $368.33 | Jan 1, 2025 | Contractor file |
| JH · Louisiana, Area 01 CMS 07202-01 | — | # | $257.91 | $245.01 | $281.76 | Jan 1, 2025 | Contractor file |
| JH · Louisiana, Area 99 CMS 07202-99 | — | — | $321.89 | $305.80 | $351.67 | Jan 1, 2025 | Contractor file |
| JH · Louisiana, Area 99 CMS 07202-99 | — | # | $247.23 | $234.87 | $270.10 | Jan 1, 2025 | Contractor file |
| JH · Mississippi, Area 00 CMS 07302-00 | — | — | $312.41 | $296.79 | $341.31 | Jan 1, 2025 | Contractor file |
| JH · Mississippi, Area 00 CMS 07302-00 | — | # | $240.21 | $228.20 | $262.43 | Jan 1, 2025 | Contractor file |
| JH · Oklahoma, Area 00 CMS 04312-00 | — | — | $322.57 | $306.44 | $352.41 | Jan 1, 2025 | Contractor file |
| JH · Oklahoma, Area 00 CMS 04312-00 | — | # | $247.06 | $234.71 | $269.92 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 09 CMS 04412-09 | — | — | $352.21 | $334.60 | $384.79 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 09 CMS 04412-09 | — | # | $266.95 | $253.60 | $291.64 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 11 CMS 04412-11 | — | — | $353.05 | $335.40 | $385.71 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 11 CMS 04412-11 | — | # | $267.71 | $254.32 | $292.47 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 15 CMS 04412-15 | — | — | $351.36 | $333.79 | $383.86 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 15 CMS 04412-15 | — | # | $266.61 | $253.28 | $291.27 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 18 CMS 04412-18 | — | — | $358.02 | $340.12 | $391.14 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 18 CMS 04412-18 | — | # | $273.01 | $259.36 | $298.26 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 20 CMS 04412-20 | — | — | $326.98 | $310.63 | $357.22 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 20 CMS 04412-20 | — | # | $250.45 | $237.93 | $273.62 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 28 CMS 04412-28 | — | — | $351.09 | $333.54 | $383.57 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 28 CMS 04412-28 | — | # | $266.51 | $253.18 | $291.16 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 31 CMS 04412-31 | — | — | $362.10 | $344.00 | $395.60 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 31 CMS 04412-31 | — | # | $273.45 | $259.78 | $298.75 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 99 CMS 04412-99 | — | — | $337.26 | $320.40 | $368.46 | Jan 1, 2025 | Contractor file |
| JH · Texas, Area 99 CMS 04412-99 | — | # | $257.17 | $244.31 | $280.96 | Jan 1, 2025 | Contractor file |
| JN · Florida, Area 03 CMS 09102-03 | — | — | $359.33 | $341.36 | $392.56 | Jan 1, 2025 | Contractor file |
| JN · Florida, Area 03 CMS 09102-03 | — | # | $274.75 | $261.01 | $300.16 | Jan 1, 2025 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | — | — | $374.32 | $355.60 | $408.94 | Jan 1, 2025 | Contractor file |
| JN · Florida, Area 04 CMS 09102-04 | — | # | $287.28 | $272.92 | $313.86 | Jan 1, 2025 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | — | — | $341.71 | $324.62 | $373.31 | Jan 1, 2025 | Contractor file |
| JN · Florida, Area 99 CMS 09102-99 | — | # | $262.04 | $248.94 | $286.28 | Jan 1, 2025 | 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.
Payment considerations Copy link
Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.
Other payment indicators (5)
Facility/non-facility: Not determined, Professional/technical component: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply.
Why would a Medicare claim for 0869T 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
- Assistant at surgery: never separately payable. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
- Multiple procedures: standard reduction applies. 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.
Reconciling a contractor-priced payment for 0869T Copy link
There is no national allowed amount for 0869T, 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 check
- 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.
- Look for modifier 50 or a second-side line before comparing: billed for both sides, this procedure should price at 150% of the single-side amount.
- 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.
Codes to compare
National Q4 2025 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.
None of the comparison codes are 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).
Which billing rules and modifiers apply? Copy link
Global period: what 0869T's fee already covers Copy link
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
These billing-policy indicators explain how 0869T is treated. They apply whether the code is nationally priced or carrier-priced: a restriction like "bilateral not allowed" still matters on a carrier-priced code.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 1 | 150% bilateral adjustment applies. Billed bilaterally (modifier 50, or on both sides), Medicare pays 150% of the single-side fee schedule amount. |
| Assistant at surgery | 1 | Never separately payable. An assistant at surgery may never be separately paid for this procedure—a statutory restriction. |
| 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. When billed with other procedures on the same date, the highest-valued one is paid at 100% and the next four at 50% each. |
| 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
Check a pair of codes 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 for the pair.
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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Source & method
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Contractor amounts come from the MAC-published schedules and effective dates shown above. The PFS file shows this code is priced by the contractor. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.
Cite this rate
The citation names the release, so anyone can check it even after CMS publishes a newer one.
CPT 0869T National PFS baseline: No national PFS rate (Q4 2025; participating; whole service; GPCI 1.000; sequestration excluded). CMS RVU25D, PPRRVU2025_Oct.csv row 902. Localis. https://localishealth.com/cpt/0869T/2025/D