CPT 15876
Restricted / special payment rules
15876 · PFS Q4 2026 · Upcoming
No national PFS rate in Q4 2026
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 published status R (restricted) for CPT 15876 in the Q4 2026 Physician Fee Schedule, with no national PFS amount. These figures take effect for dates of service beginning Oct 1, 2026. Treat the blank amount as unpriced, not as $0.
PFS status evidence
Inspect PFS status evidence
- Code
- 15876
- Release
- Q4 2026, revision 2
- Result
- Restricted / special payment rules
Citations
-
Establishes the PFS status (R) and the resulting pathway for this code: restricted / special payment rules.
Physician relative value file (PPRRVU)Q4 2026 · revision 2
Latest revision of this release
Release period: October 1 – December 31, 2026
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
Record details
PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip (row 1,589)- hcpcs (col 1)
- 15876
- modifier (col 2)
- blank
- status_code (col 4)
- R
- work_rvu (col 6)
- 0
- pe_rvu_nonfacility (col 7)
- 0
- pe_rvu_facility (col 9)
- 0
- mp_rvu (col 11)
- 0
SHA-256: 4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626
Why is there no national PFS amount for 15876?
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.
Payment considerations Copy link
Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.
Other payment indicators (8)
Facility/non-facility: Does not apply, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.
Payment review for 15876 Copy link
Four published payment rules can change what 15876 allows on a claim: status R coverage instructions, the same-day global package, the standard multiple-procedure reduction and documentation-restricted assistant-at-surgery payment. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.
What to reconcile
- 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.
- 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.
Nearby payment lines
National Q4 2026 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.
No comparison lines are present 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); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
Global period: what 15876's fee already covers Copy link
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.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
Billing policy Copy link
What 15876's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 0 | No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure. |
| Assistant at surgery | 0 | Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity. |
| 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. The same standard ranking-and-reduction rule as indicator 1 applies to this procedure when billed with others on the same date. |
| 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
Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 15876.
Billing together (NCCI edits) Copy link
NCCI Q4 2026Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.
Not separately payable with 15876 on the same date of service—no modifier bypasses the edit (modifier indicator 0)
Showing 3 of 72.
Separately payable with 15876 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)
Showing 3 of 168.
Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.
Common payment questions Copy link
Why would a Medicare claim for 15876 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
- 72 codes form NCCI pairs with 15876 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
- 168 codes pair with 15876 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
- 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
- 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.
Rate history by release Copy link
National non-facility amount for 15876 across quarterly releases.
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q4 2026 takes effect Oct 1, 2026 | R | — | — |
| Q3 2026 Jul 1, 2026 – Sep 30, 2026 | R | — | — |
| Q2 2026 Apr 1, 2026 – Jun 30, 2026 | R | — | — |
| Q1 2026 Jan 1, 2026 – Mar 31, 2026 | R | — | — |
| Q4 2025 Oct 1, 2025 – Dec 31, 2025 | R | — | — |
| Q3 2025 Jul 1, 2025 – Sep 30, 2025 | R | — | — |
| Q2 2025 Apr 1, 2025 – Jun 30, 2025 | R | — | — |
| Q1 2025 Jan 1, 2025 – Mar 31, 2025 | R | — | — |
| Q4 2024 Oct 1, 2024 – Dec 31, 2024 | R | — | — |
| Q3 2024 Jul 1, 2024 – Sep 30, 2024 | R | — | — |
| Q2 2024 Apr 1, 2024 – Jun 30, 2024 | R | — | — |
| Q1 2024 Mar 9, 2024 – Mar 31, 2024 | R | — | — |
| Q1 2024 Jan 1, 2024 – Mar 8, 2024 | R | — | — |
| Q4 2023 Oct 1, 2023 – Dec 31, 2023 | R | — | — |
| Q3 2023 Jul 1, 2023 – Sep 30, 2023 | R | — | — |
| Q2 2023 Apr 1, 2023 – Jun 30, 2023 | R | — | — |
| Q1 2023 Jan 1, 2023 – Mar 31, 2023 | R | — | — |
| Q4 2022 Oct 1, 2022 – Dec 31, 2022 | R | — | — |
| Q3 2022 Jul 1, 2022 – Sep 30, 2022 | R | — | — |
| Q2 2022 Apr 1, 2022 – Jun 30, 2022 | R | — | — |
| Q1 2022 Jan 1, 2022 – Mar 31, 2022 | R | — | — |
| Q4 2021 Oct 1, 2021 – Dec 31, 2021 | R | — | — |
| Q3 2021 Jul 1, 2021 – Sep 30, 2021 | R | — | — |
| Q2 2021 Apr 1, 2021 – Jun 30, 2021 | R | — | — |
| Q1 2021 Jan 1, 2021 – Mar 31, 2021 | R | — | — |
| Q4 2020 Oct 1, 2020 – Dec 31, 2020 | R | — | — |
| Q3 2020 Jul 1, 2020 – Sep 30, 2020 | R | — | — |
| Q2 2020 Apr 1, 2020 – Jun 30, 2020 | R | — | — |
| Q1 2020 Jan 1, 2020 – Mar 31, 2020 | R | — | — |
| Q4 2019 Oct 1, 2019 – Dec 31, 2019 | R | — | — |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | R | — | — |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | R | — | — |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | R | — | — |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | R | — | — |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | R | — | — |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | R | — | — |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | R | — | — |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | R | — | — |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | R | — | — |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | R | — | — |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | R | — | — |
| Q4 2016 Oct 1, 2016 – Dec 31, 2016 | R | — | — |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | R | — | — |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | R | — | — |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | R | — | — |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | R | — | — |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | R | — | — |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | R | — | — |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | R | — | — |
| Q4 2014 Oct 1, 2014 – Dec 31, 2014 | R | — | — |
| Q3 2014 Jul 1, 2014 – Sep 30, 2014 | R | — | — |
| Q2 2014 Apr 1, 2014 – Jun 30, 2014 | R | — | — |
| Q1 2013 Jan 1, 2013 – Mar 31, 2013 | R | — | — |
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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This page uses CMS's Medicare Physician Fee Schedule Q4 2026 release (effective October 2026). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This citation identifies the source release, so its evidence remains reproducible after a newer release lands.
CPT 15876 National PFS baseline: No national PFS rate (Q4 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/15876/2026/D