localis
Calculator

Describe a service in plain words, or type a CPT/HCPCS code.

CPT 22526 Medicare payment status

Excluded from PFS

22526 · PFS Q4 2026

Status N: non-covered. Medicare covers no part of this service, so the PFS produces no payment amount.

View applicable payment rules
View CMS source and method

CMS RVU26DOctober 1 – December 31, 2026revision 2

PFS status evidence

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 2,077)
Inspect PFS status evidence
Code
22526
Release
Q4 2026, revision 2
Result
Excluded from PFS

Citations

  • Shows this code’s PFS status (N). Result: Excluded from PFS.

    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 2,077 in rvu26d-updated-08-26-2026.zip

    In the CMS file

    Loading rows 2,075–2,079 of PPRRVU2026_Oct_nonQPP.csv…

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

Plain-text summaryReport a problem

CPT 22526 has no published national rate. It carries status N (non-covered) in the Q4 2026 release. Medicare covers no part of this service. The blank amount means unpriced, not $0.

Why is there no national PFS amount for 22526?

Its status indicator is N (non-covered). Medicare covers no part of this service. Status N: non-covered. Medicare covers no part of this service, so the PFS produces no payment amount.

Payment considerations Copy link

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

Global surgery Applies NCCI same-day edits Applies MUE behavior Applies
Other payment indicators (7)
Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.
Why would a Medicare claim for 22526 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • Its status indicator is N (non-covered)—Medicare covers no part of this service. See status indicators
  • 25 codes form NCCI pairs with 22526 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
  • 129 codes pair with 22526 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 0 units per patient per date of service exceeds 22526's Medically Unlikely Edit (MUE) limit. See billing together
  • 22526 carries a 10-day global period—routine post-operative care within that window is included in the surgical payment rather than paid on its own claim. See how it's computed

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.

Which billing rules and modifiers apply? Copy link

Global period: what 22526's fee already covers Copy link

010 10-day follow-up

The fee covers pre-operative work on the day of the procedure plus related follow-up care for the next 10 days. Related visits inside that window are not billed separately.

Billing a related follow-up visit inside the 10-day window is the most common way this code gets denied—the payment for that care is already inside the 22526 fee.

Modifiers that report work outside 22526's global period
Modifier Reports
-25 A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care.
-24 An E/M during the follow-up window that is unrelated to this surgery, so it is paid separately.
-58 A staged or more extensive follow-on procedure during the window. Starts a new follow-up period.
-78 An unplanned return to the operating room for a related procedure during the window. Does not start a new follow-up period.
-79 An unrelated procedure by the same physician during the window. Starts a new follow-up period.

A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.

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.

See every current NCCI pair for 22526 →

Billing together (NCCI edits) Copy link

NCCI Q4 2026

Based 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 22526 on the same date of service—no modifier bypasses the edit (modifier indicator 0)

36591 36591 denies
36592 36592 denies
64461 64461 denies

Showing 3 of 25.

Separately payable with 22526 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

0202T 0202T denies
0719T 0719T denies
11000 11000 denies

Showing 3 of 129.

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.

Check a paired code or view all 154 NCCI pairs →

Medically Unlikely Edit (MUE) limit: 0 units per patient per date of service.

Why a 22526 line may not pay separately Copy link

CMS publishes no separately payable amount for 22526 in this release, so reconciling the line means establishing which status governed the date of service rather than chasing a fee-schedule difference.

What to check

  • Confirm the status that governed the date of service before working this line as a short payment—CMS publishes no separately payable fee-schedule amount for it in this release.
  • Check the dates before appealing a denial: related follow-up care in the 10 days after the procedure is already paid in this fee, so a post-operative visit denied in that window was denied correctly.
  • 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.
Check an actual payment Model this code in a contract

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).

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for 22526 across quarterly releases.

Release Status Office Facility
Q4 2026 Oct 1, 2026 – present N — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 N — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 N — —
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.

Did this answer your question about CPT 22526?

Tell us what you were trying to work out and we'll answer you or build the page that does.

Did this page answer your question?

Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2026 release (effective October 2026). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. 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.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 2,077)

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

CPT 22526 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 2,077. Localis. https://localishealth.com/cpt/22526/2026/D