{
    "code": "28825",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/28825",
    "release_specific_url": "https://localishealth.com/cpt/28825/2026/D",
    "answer": {
        "question": "What is the Medicare allowed amount for CPT 28825 in 2026?",
        "text": "The national PFS baseline is $289.92 for CPT 28825 in the Office (non-facility) setting and $156.32 in a facility under the Q4 2026 Physician Fee Schedule, effective October 2026. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded. Across payment localities, the office amount is $260.20–$369.45 and the facility amount is $145.43–$208.02. This amount has been unchanged since Q1 2026, when it increased 3.6%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2026,
        "quarter": "D",
        "label": "Q4 2026",
        "effective": "October 1 – December 31, 2026",
        "revision": 2
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 289.92,
        "facility": 156.32,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 3.32,
        "practice_expense_non_facility": 4.97,
        "practice_expense_facility": 0.97,
        "malpractice": 0.39
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 33.4009,
    "ncci": {
        "release": "Q4 2026",
        "never_billable_pair_count": 66,
        "modifier_allowed_pair_count": 211,
        "mue_units_per_date_of_service": 8,
        "url": "https://localishealth.com/cpt/28825/ncci-edits",
        "complete_text_url": "https://localishealth.com/cpt/28825/ncci-edits.txt"
    },
    "source": {
        "label": "Physician relative value file (Q4 2026)",
        "cms_url": "https://www.cms.gov/files/zip/rvu26d-updated-08-26-2026.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2026/D",
        "file": "PPRRVU2026_Oct_nonQPP.csv",
        "row": 3259,
        "sha256": "4d0d3f19bd954ffc0f5b8439169d267da023d4f6911f4539bb6e98723cb1a626"
    },
    "modified_at": "2026-09-01T06:33:29+00:00"
}