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CPT 0935T Medicare payment status

Contractor-priced

0935T · PFS Q4 2026

No national PFS rate in Q4 2026

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

PFS status evidence

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 969)
Inspect PFS status evidence
Code
0935T
Release
Q4 2026, revision 2
Result
Contractor-priced

Citations

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

    Physician relative value file (PPRRVU)CMS RVU26DOctober 1 – December 31, 2026revision 2

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

    PPRRVU2026_Oct_nonQPP.csv row 969 in rvu26d-updated-08-26-2026.zip

    In the CMS file

    Loading rows 967–971 of PPRRVU2026_Oct_nonQPP.csv…

    Download rvu26d-updated-08-26-2026.zip from CMS File fingerprint 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626

Report a problem

CPT 0935T has no published national rate. It carries status C (carrier-priced) in the Q4 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).

Global surgery period

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.

Multiple procedures

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
  • 106 codes form NCCI pairs with 0935T carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
  • 112 codes pair with 0935T under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
  • More than 1 unit per patient per date of service exceeds 0935T's Medically Unlikely Edit (MUE) limit. See billing together
  • 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 RVU26DOctober 1 – December 31, 2026revision 2

Can you bill it with another code? Copy link

0935T has 218 NCCI pairs (Q4 2026) and an MUE of 1 unit per patient per date of service.

This code

0935T

Modifier indicator 0

106 pairs

No modifier bypasses the edit

Modifier indicator 1

112 pairs

Only with an appropriate, documented modifier

Medically Unlikely Edit (MUE) limit

1 unit

Per patient per date of service

All 218 NCCI pairs for 0935T →

Reconciling a contractor-priced payment for 0935T Copy link

Checking a paid 0935T line?

Check an actual payment Model this code in a contract
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.

  1. 01 PPRRVU2026_Oct_nonQPP.csv · Q4 2026 (RVU26D) · row 969—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q4 2026 release
    Effective
    October 1 – December 31, 2026
    Locator
    PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip · row 969 of 19,453 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 4d0d3f19bd954ffc…
  2. 02 NCCI · Q4 2026—the code-pair edits
    Source
    National Correct Coding Initiative (NCCI)
    Effective
    Same quarter as the Q4 2026 rate

Cite this rate

CPT 0935T National PFS baseline: No national PFS rate (Q4 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26D, PPRRVU2026_Oct_nonQPP.csv row 969. Localis. https://localishealth.com/cpt/0935T/2026/D

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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