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CPT 22526

Excluded from PFS

22526 · PFS Q4 2018 · Historical

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

CPT 22526 has no published national rate. It carries status N (non-covered) in the Q4 2018 release. Medicare covers no part of this service. The blank amount means unpriced, not $0.

PFS status evidence

Physician relative value file (Q4 2018) · rvu18d.zip (PPRRVU18_OCT.csv row 6,061)
Inspect PFS status evidence
Code
22526
Release
Q4 2018, revision 1
Result
Excluded from PFS

Citations

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

    Physician relative value file (PPRRVU)

    Q4 2018 · revision 1

    Latest revision of this release

    Release period: October 1 – December 31, 2018

    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 PPRRVU18_OCT.csv in rvu18d.zip (row 6,061)
    hcpcs (col 1)
    22526
    modifier (col 2)
    blank
    status_code (col 4)
    N

    SHA-256: c6312c12acd1b8ed78b409e8508357929aa7e764e333ec568ebb9c0774b7dc4d

    Original source file

Plain-text summary

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
Other payment indicators (9)

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, NCCI same-day edits: Not determined, MUE behavior: Not determined, 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
  • 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.

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.

Codes to compare

National Q4 2018 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

None of the comparison codes are in this release.

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).

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 →

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 takes effect Oct 1, 2026 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?

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2018 release (effective October 2018). 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 2018) · rvu18d.zip (PPRRVU18_OCT.csv row 6,061)

Use the (i) buttons next to each amount above for the exact row, columns, and math.

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 2018; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/22526/2018/D