Restricted / special payment rules
15828 · PFS Q1 2013 · Historical
No national PFS rate in Q1 2013
Status R: no national PFS amount. The RVUs for this setting are all zero; they do not establish a $0 allowance. Special payment instructions apply.
CMS RVU13AJanuary 1 – March 31, 2013revision 2
PFS status evidence
Inspect PFS status evidence
- Code
- 15828
- Release
- Q1 2013, revision 2
- Result
- Restricted / special payment rules
Citations
-
Shows this code’s PFS status (R). Result: Restricted / special payment rules.
Physician relative value file (PPRRVU)CMS RVU13AJanuary 1 – March 31, 2013revision 2
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU13_V1226_UP0.csv row 4,774 in rvu13ar.zip
In the CMS file
Loading rows 4,772–4,776 of PPRRVU13_V1226_UP0.csv…
Download rvu13ar.zip from CMS File fingerprint
79b1988bb9cbab6a61634b6463d26ce88cca431c3e36fa3b73792f29882d95b4
CPT 15828 has no published national rate. It carries status R (restricted) in the Q1 2013 release. Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. The blank amount means unpriced, not $0.
Why is there no national PFS amount for 15828?
Its status indicator is R (restricted). Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. Status R: no national PFS amount. The RVUs for this setting are all zero; they do not establish a $0 allowance. Special payment instructions apply.
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to 15828: GLOB DAYS 000 (same day only) · BILAT SURG 1 (150% bilateral adjustment applies) · MULT PROC 2 (standard reduction applies).
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.
150% bilateral adjustment applies
BILAT SURG
1
Billed bilaterally (modifier 50, or on both sides), Medicare pays 150% of the single-side fee schedule amount.
Standard reduction applies
MULT PROC
2
When billed with other procedures on the same date, the highest-valued one is paid at 100% and the next four at 50% each.
-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 15828 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is R (restricted)—Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. See status indicators
- Assistant at surgery: restricted without documentation. 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.
CMS RVU13AJanuary 1 – March 31, 2013revision 2
Can you bill it with another code? Copy link
Payment review for 15828 Copy link
What to check (5)
Four published payment rules can change what 15828 allows on a claim: status R coverage instructions, the same-day global package, the standard multiple-procedure reduction and the 150% bilateral adjustment. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.
- Treat the published amount as conditional—status R carries special coverage instructions, so a payable fee-schedule amount does not by itself establish that this line should have paid.
- 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.
- 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.
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
-
01 PPRRVU13_V1226_UP0.csv · Q1 2013 (RVU13A) · row 4,774—status R, RVUs limits
- Effective
- January 1 – March 31, 2013
- Locator
- PPRRVU13_V1226_UP0.csv in rvu13ar.zip · row 4,774 of 15,619 · via CMS
- Fields read
-
Status R (col 4) Work RVU 0 (col 6) Office (non-facility) PE RVU 0 (col 7) Facility PE RVU 0 (col 9) Malpractice RVU 0 (col 11)SHA-256 79b1988bb9cbab6a…
- Doesn’t establish
- A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
- Note
- Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
Cite this rate
CPT 15828 National PFS baseline: No national PFS rate (Q1 2013; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU13A, PPRRVU13_V1226_UP0.csv row 4,774. Localis. https://localishealth.com/cpt/15828/2013/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
— Office (non-facility) and — Facility since Jan 1, 2013.
-
Jan 1, 2024 – Mar 8, 2024 · Superseded revision
Q1 2024 rev 1
Revision 1, later corrected by CMS- Office
- —
- Facility
- —
-
Jan 1, 2013 – present
Q1 2013
Still in effect · 53 releases at this rate- Office
- —
- Facility
- —
Q1 2013 Jan 1, 2013 – Mar 31, 2013 · Q2 2013 Apr 1, 2013 – Jun 30, 2013 · Q2 2014 Apr 1, 2014 – Jun 30, 2014 · Q3 2014 Jul 1, 2014 – Sep 30, 2014 · Q4 2014 Oct 1, 2014 – Dec 31, 2014 · Q1 2015 Jan 1, 2015 – Mar 31, 2015 · Q2 2015 Apr 1, 2015 – Jun 30, 2015 · Q3 2015 Jul 1, 2015 – Sep 30, 2015 · Q4 2015 Oct 1, 2015 – Dec 31, 2015 · Q1 2016 Jan 1, 2016 – Mar 31, 2016 · Q2 2016 Apr 1, 2016 – Jun 30, 2016 · Q3 2016 Jul 1, 2016 – Sep 30, 2016 · Q4 2016 Oct 1, 2016 – Dec 31, 2016 · Q1 2017 Jan 1, 2017 – Mar 31, 2017 · Q2 2017 Apr 1, 2017 – Jun 30, 2017 · Q3 2017 Jul 1, 2017 – Sep 30, 2017 · Q4 2017 Oct 1, 2017 – Dec 31, 2017 · Q1 2018 Jan 1, 2018 – Mar 31, 2018 · Q2 2018 Apr 1, 2018 – Jun 30, 2018 · Q3 2018 Jul 1, 2018 – Sep 30, 2018 · Q4 2018 Oct 1, 2018 – Dec 31, 2018 · Q1 2019 Jan 1, 2019 – Mar 31, 2019 · Q2 2019 Apr 1, 2019 – Jun 30, 2019 · Q3 2019 Jul 1, 2019 – Sep 30, 2019 · Q4 2019 Oct 1, 2019 – Dec 31, 2019 · Q1 2020 Jan 1, 2020 – Mar 31, 2020 · Q2 2020 Apr 1, 2020 – Jun 30, 2020 · Q3 2020 Jul 1, 2020 – Sep 30, 2020 · Q4 2020 Oct 1, 2020 – Dec 31, 2020 · Q1 2021 Jan 1, 2021 – Mar 31, 2021 · Q2 2021 Apr 1, 2021 – Jun 30, 2021 · Q3 2021 Jul 1, 2021 – Sep 30, 2021 · Q4 2021 Oct 1, 2021 – Dec 31, 2021 · Q1 2022 Jan 1, 2022 – Mar 31, 2022 · Q2 2022 Apr 1, 2022 – Jun 30, 2022 · Q3 2022 Jul 1, 2022 – Sep 30, 2022 · Q4 2022 Oct 1, 2022 – Dec 31, 2022 · Q1 2023 Jan 1, 2023 – Mar 31, 2023 · Q2 2023 Apr 1, 2023 – Jun 30, 2023 · Q3 2023 Jul 1, 2023 – Sep 30, 2023 · Q4 2023 Oct 1, 2023 – Dec 31, 2023 · Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024 · Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025 · Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present
Earliest release in this history.
National baseline (GPCI 1.000), before sequestration.
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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