Unable to determine from available CMS sources
27215 · PFS Q3 2026 · Historical
Status I is not separately payable under the PFS.
CMS RVU26CJuly 1 – September 30, 2026
PFS status evidence
Inspect PFS status evidence
- Code
- 27215
- Release
- Q3 2026, revision 1
- Result
- Unable to determine from available CMS sources
Citations
-
Shows this code’s PFS status (I). Result: Unable to determine from available CMS sources.
Physician relative value file (PPRRVU)CMS RVU26CJuly 1 – September 30, 2026
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU2026_Jul_nonQPP.csv row 2,726 in rvu26c-updated-06-30-2026.zip
In the CMS file
Loading rows 2,724–2,728 of PPRRVU2026_Jul_nonQPP.csv…
Download rvu26c-updated-06-30-2026.zip from CMS File fingerprint
b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21
CPT 27215 has no published national rate. It carries status I (not valid) in the Q3 2026 release. Medicare uses a different code to report and pay for this service. The blank amount means unpriced, not $0.
Why is there no national PFS amount for 27215?
Its status indicator is I (not valid). Medicare uses a different code to report and pay for this service. Status I is not separately payable under the PFS.
Which billing rules and modifiers apply? Copy link
CMS indicators that apply to 27215: GLOB DAYS 090 (90-day follow-up).
90-day follow-up
GLOB DAYS
090
Major surgery. The fee covers the day before surgery, the day of surgery, and the 90 days after it. Related follow-up care inside that window is not billed separately.
Why would a Medicare claim for 27215 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is I (not valid)—Medicare uses a different code to report and pay for this service. See status indicators
- 57 codes form NCCI pairs with 27215 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
- 145 codes pair with 27215 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
- 27215 carries a 90-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.
CMS RVU26CJuly 1 – September 30, 2026
Can you bill it with another code? Copy link
27215 has 202 NCCI pairs (Q3 2026).
Why a 27215 line may not pay separately Copy link
What to check (4)
CMS publishes no separately payable amount for 27215 in this release, so reconciling the line means establishing which status governed the date of service rather than chasing a fee-schedule difference.
- 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 place of service: CMS marks this code facility-only (an NA in the non-facility NA indicator) and developed no Office (non-facility) practice-expense RVUs for it; the file’s non-facility column repeats the facility value.
- Check the dates before appealing a denial: related follow-up care in the 90 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.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Practice Expense methodology (cms.gov); CMS Medicare Claims Processing Manual (Pub. 100-04).
Source & method Copy link
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01 PPRRVU2026_Jul_nonQPP.csv · Q3 2026 (RVU26C) · row 2,726—status I, RVUs limits
- Effective
- July 1 – September 30, 2026
- Locator
- PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip · row 2,726 of 19,356 · via CMS
- Fields read
-
Status I (col 4)SHA-256 b7d197e73211ef68…
- 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.
-
02 NCCI · Q3 2026—the code-pair edits
- Source
- National Correct Coding Initiative (NCCI)
- Effective
- Same quarter as the Q3 2026 rate
Cite this rate
CPT 27215 National PFS baseline: No national PFS rate (Q3 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26C, PPRRVU2026_Jul_nonQPP.csv row 2,726. Localis. https://localishealth.com/cpt/27215/2026/C
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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