Contractor-priced
0935T · PFS Q2 2026 · Historical
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.
PFS status evidence
Inspect PFS status evidence
- Code
- 0935T
- Release
- Q2 2026, revision 1
- Result
- Contractor-priced
Citations
-
Shows this code’s PFS status (C). Result: Contractor-priced.
Physician relative value file (PPRRVU)CMS RVU26BApril 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.
PPRRVU2026_Apr_nonQPP.csv row 969 in rvu26b-updated-05-01-2026.zip
In the CMS file
Loading rows 967–971 of PPRRVU2026_Apr_nonQPP.csv…
Download rvu26b-updated-05-01-2026.zip from CMS File fingerprint
afc9cf9fe60742518cf6aaccd507edc035052ab9ab1be48644be39f38fceec48
CPT 0935T has no published national rate. It carries status C (carrier-priced) in the Q2 2026 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank amount means unpriced, not $0.
Why is there no national PFS amount for 0935T?
Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to 0935T: GLOB DAYS 000 (same day only) · MULT PROC 3 (special endoscopic rules apply).
Same day only
GLOB DAYS
000
The fee covers pre-operative and post-operative work on the day of the procedure only—there is no follow-up window afterward. A visit the next day is separately payable.
Special endoscopic rules apply
MULT PROC
3
This procedure is part of an endoscopic family; payment is based on the endoscopic base procedure rather than the standard multiple-procedure reduction.
-51 depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one.
Why would a Medicare claim for 0935T 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: special endoscopic rules apply. 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 RVU26BApril 1 – June 30, 2026
Can you bill it with another code? Copy link
Reconciling a contractor-priced payment for 0935T Copy link
What to check (5)
There is no national allowed amount for 0935T, 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.
- Check the visit date: this code carries no follow-up window, so a related visit the day after the procedure is separately payable and should not have bundled.
- Check the other endoscopies on the claim: payment here is built from base code 52000, worth $215.77 nationally at GPCI 1.000, so a second scope from that family pays its own amount less the base code’s rather than in full.
- Check whether a second side was billed separately—the published RVUs already price both sides, so there is no additional amount behind that line.
- 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).
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.
-
01 PPRRVU2026_Apr_nonQPP.csv · Q2 2026 (RVU26B) · row 969—priced by the contractor
- Effective
- April 1 – June 30, 2026
- Locator
- PPRRVU2026_Apr_nonQPP.csv in rvu26b-updated-05-01-2026.zip · row 969 of 19,277 · via CMS
- Fields read
-
Status C (col 4)SHA-256 afc9cf9fe6074251…
Cite this rate
CPT 0935T National PFS baseline: No national PFS rate (Q2 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26B, PPRRVU2026_Apr_nonQPP.csv row 969. Localis. https://localishealth.com/cpt/0935T/2026/B
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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