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CPT 43648 Medicare carrier-priced amounts

Contractor-priced

43648 · PFS Q4 2026

Contractor-published range

$318.04–$1,053.59

Participating · Office (non-facility) · Whole service

MAC-published fee schedules available in Localis: 70 of 144 payment localities. Missing data does not establish a $0 allowance.

No national PFS rate in Q4 2026

Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

Check for a published amount in your locality.

View contractor sources and effective dates

Amount evidence: MAC-published fee schedules and effective dates. The PFS row shows this code is priced by the contractor.

Inspect PFS status evidence
Code
43648
Release
Q4 2026, revision 2
Result
Contractor-priced

Citations

  • Shows this code’s PFS status (C). Result: Contractor-priced.

    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 5,278 in rvu26d-updated-08-26-2026.zip

    In the CMS file

    Loading rows 5,276–5,280 of PPRRVU2026_Oct_nonQPP.csv…

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

Report a problem

CPT 43648 carries status C (carrier-priced) in the Q4 2026 release, so there is no single national rate—Medicare contractors publish their own amounts. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. Contractor-published amounts on file range $318.04–$1,053.59 across 70 localities; enter a ZIP for the exact local amount.

Why is there no national PFS amount for 43648?

Its status indicator is C (carrier-priced). Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation.

Find the local Medicare amount for 43648 Copy link

Medicare sets this price locally

43648 has no single national Physician Fee Schedule amount. Use the ZIP, modifier, setting, and participation fields above to match it to a Medicare locality and the contractor amount we have on file.

Your practical estimate will appear here

We hold files from First_coast and Noridian and Novitas across JE and JF and JH and JL and JN, most recently effective Jan 1, 2026. A missing locality means our contractor coverage is incomplete—not that Medicare pays $0.

This is the published amount for this code—not necessarily the entire visit or procedure. A hospital may bill a separate facility charge, and other services, drugs, or supplies can add to the total.

Contractor-published source figures, not a national rate. Par = participating-provider amount Non-par = nonparticipating-provider amount C = technical component capped at the OPPS amount # = facility-setting amount
View all 93 published fee rows
Jurisdiction / locality Modifier Note Par Non-par Limiting charge Effective Source
JE · California, Area 05 CMS 01112-05 — — $339.35 $322.38 $370.74 Jan 1, 2026 Contractor file
JE · California, Area 09 CMS 01112-09 — — $339.85 $322.86 $371.29 Jan 1, 2026 Contractor file
JE · California, Area 17 CMS 01182-17 — — $333.66 $316.98 $364.53 Jan 1, 2026 Contractor file
JE · California, Area 18 CMS 01182-18 — — $336.47 $319.65 $367.60 Jan 1, 2026 Contractor file
JE · California, Area 51 CMS 01112-51 — — $328.81 $312.37 $359.23 Jan 1, 2026 Contractor file
JE · California, Area 52 CMS 01112-52 — — $328.81 $312.37 $359.23 Jan 1, 2026 Contractor file
JE · California, Area 53 CMS 01112-53 — — $328.81 $312.37 $359.23 Jan 1, 2026 Contractor file
JE · California, Area 54 CMS 01112-54 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 55 CMS 01112-55 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 56 CMS 01112-56 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 57 CMS 01112-57 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 58 CMS 01112-58 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 59 CMS 01112-59 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 60 CMS 01112-60 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 61 CMS 01112-61 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 62 CMS 01112-62 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 63 CMS 01112-63 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 64 CMS 01112-64 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 65 CMS 01112-65 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 66 CMS 01112-66 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 67 CMS 01112-67 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 68 CMS 01112-68 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 69 CMS 01112-69 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 70 CMS 01112-70 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 71 CMS 01182-71 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 72 CMS 01182-72 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 73 CMS 01182-73 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 74 CMS 01182-74 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · California, Area 75 CMS 01112-75 — — $318.04 $302.14 $347.46 Jan 1, 2026 Contractor file
JE · Hawaii, Area 01 CMS 01212-01 — — $322.14 $306.03 $351.93 Jan 1, 2026 Contractor file
JE · Nevada, Area 00 CMS 01312-00 — — $326.93 $310.58 $357.17 Jan 1, 2026 Contractor file
JF · Alaska, Area 01 CMS 02102-01 — — $1,043.34 $991.17 $1,139.85 Jan 1, 2026 Contractor file
JF · Arizona, Area 00 CMS 03102-00 — — $809.38 $768.91 $884.25 Jan 1, 2026 Contractor file
JF · Montana, Area 01 CMS 03202-01 — — $811.27 $770.71 $886.32 Jan 1, 2026 Contractor file
JF · North Dakota, Area 01 CMS 03302-01 — — $768.69 $730.26 $839.80 Jan 1, 2026 Contractor file
JF · Oregon, Area 01 CMS 02302-01 — — $782.99 $743.84 $855.42 Jan 1, 2026 Contractor file
JF · Oregon, Area 99 CMS 02302-99 — — $769.06 $730.61 $840.20 Jan 1, 2026 Contractor file
JF · South Dakota, Area 02 CMS 03402-02 — — $765.84 $727.55 $836.68 Jan 1, 2026 Contractor file
JF · Utah, Area 09 CMS 03502-09 — — $815.86 $775.07 $891.33 Jan 1, 2026 Contractor file
JF · Washington, Area 02 CMS 02402-02 — — $836.10 $794.30 $913.45 Jan 1, 2026 Contractor file
JF · Washington, Area 99 CMS 02402-99 — — $797.43 $757.56 $871.19 Jan 1, 2026 Contractor file
JF · Wyoming, Area 21 CMS 03602-21 — — $827.43 $786.06 $903.97 Jan 1, 2026 Contractor file
JH · Arkansas, Area 13 CMS 07102-13 — — $478.68 $454.75 $522.96 Jan 1, 2026 Contractor file
JH · Arkansas, Area 13 CMS 07102-13 — # $219.95 $208.95 $240.29 Jan 1, 2026 Contractor file
JH · Colorado, Area 01 CMS 04112-01 — — $531.61 $505.03 $580.78 Jan 1, 2026 Contractor file
JH · Colorado, Area 01 CMS 04112-01 — # $239.35 $227.38 $261.49 Jan 1, 2026 Contractor file
JH · Louisiana, Area 01 CMS 07202-01 — — $527.22 $500.86 $575.99 Jan 1, 2026 Contractor file
JH · Louisiana, Area 01 CMS 07202-01 — # $238.19 $226.28 $260.22 Jan 1, 2026 Contractor file
JH · Louisiana, Area 99 CMS 07202-99 — — $493.98 $469.28 $539.67 Jan 1, 2026 Contractor file
JH · Louisiana, Area 99 CMS 07202-99 — # $226.14 $214.83 $247.05 Jan 1, 2026 Contractor file
JH · Mississippi, Area 00 CMS 07302-00 — — $491.78 $467.19 $537.27 Jan 1, 2026 Contractor file
JH · Mississippi, Area 00 CMS 07302-00 — # $225.44 $214.17 $246.30 Jan 1, 2026 Contractor file
JH · New Mexico, Area 05 CMS 04212-05 — — $511.84 $486.25 $559.19 Jan 1, 2026 Contractor file
JH · New Mexico, Area 05 CMS 04212-05 — # $232.48 $220.86 $253.99 Jan 1, 2026 Contractor file
JH · Oklahoma, Area 00 CMS 04312-00 — — $477.31 $453.44 $521.46 Jan 1, 2026 Contractor file
JH · Oklahoma, Area 00 CMS 04312-00 — # $217.91 $207.01 $238.06 Jan 1, 2026 Contractor file
JH · Texas, Area 09 CMS 04412-09 — — $532.30 $505.69 $581.54 Jan 1, 2026 Contractor file
JH · Texas, Area 09 CMS 04412-09 — # $240.44 $228.42 $262.68 Jan 1, 2026 Contractor file
JH · Texas, Area 11 CMS 04412-11 — — $536.48 $509.66 $586.11 Jan 1, 2026 Contractor file
JH · Texas, Area 11 CMS 04412-11 — # $241.61 $229.53 $263.96 Jan 1, 2026 Contractor file
JH · Texas, Area 15 CMS 04412-15 — — $537.21 $510.35 $586.90 Jan 1, 2026 Contractor file
JH · Texas, Area 15 CMS 04412-15 — # $242.33 $230.21 $264.74 Jan 1, 2026 Contractor file
JH · Texas, Area 18 CMS 04412-18 — — $536.22 $509.41 $585.82 Jan 1, 2026 Contractor file
JH · Texas, Area 18 CMS 04412-18 — # $241.80 $229.71 $264.17 Jan 1, 2026 Contractor file
JH · Texas, Area 20 CMS 04412-20 — — $499.58 $474.60 $545.79 Jan 1, 2026 Contractor file
JH · Texas, Area 20 CMS 04412-20 — # $227.12 $215.76 $248.12 Jan 1, 2026 Contractor file
JH · Texas, Area 28 CMS 04412-28 — — $523.86 $497.67 $572.32 Jan 1, 2026 Contractor file
JH · Texas, Area 28 CMS 04412-28 — # $236.68 $224.85 $258.58 Jan 1, 2026 Contractor file
JH · Texas, Area 31 CMS 04412-31 — — $525.10 $498.85 $573.68 Jan 1, 2026 Contractor file
JH · Texas, Area 31 CMS 04412-31 — # $236.08 $224.28 $257.92 Jan 1, 2026 Contractor file
JH · Texas, Area 99 CMS 04412-99 — — $500.92 $475.87 $547.25 Jan 1, 2026 Contractor file
JH · Texas, Area 99 CMS 04412-99 — # $227.64 $216.26 $248.70 Jan 1, 2026 Contractor file
JL · Delaware, Area 01 CMS 12102-01 — — $537.55 $510.67 $587.27 Jan 1, 2026 Contractor file
JL · Delaware, Area 01 CMS 12102-01 — # $241.64 $229.56 $263.99 Jan 1, 2026 Contractor file
JL · District of Columbia, Area 01 CMS 12202-01 — — $605.47 $575.20 $661.48 Jan 1, 2026 Contractor file
JL · District of Columbia, Area 01 CMS 12202-01 — # $268.52 $255.09 $293.35 Jan 1, 2026 Contractor file
JL · Maryland, Area 01 CMS 12302-01 — — $577.02 $548.17 $630.40 Jan 1, 2026 Contractor file
JL · Maryland, Area 01 CMS 12302-01 — # $257.74 $244.85 $281.58 Jan 1, 2026 Contractor file
JL · Maryland, Area 99 CMS 12302-99 — — $547.98 $520.58 $598.67 Jan 1, 2026 Contractor file
JL · Maryland, Area 99 CMS 12302-99 — # $246.17 $233.86 $268.94 Jan 1, 2026 Contractor file
JL · New Jersey, Area 01 CMS 12402-01 — — $597.65 $567.77 $652.94 Jan 1, 2026 Contractor file
JL · New Jersey, Area 01 CMS 12402-01 — # $265.27 $252.01 $289.81 Jan 1, 2026 Contractor file
JL · New Jersey, Area 99 CMS 12402-99 — — $576.56 $547.73 $629.89 Jan 1, 2026 Contractor file
JL · New Jersey, Area 99 CMS 12402-99 — # $256.76 $243.92 $280.51 Jan 1, 2026 Contractor file
JL · Pennsylvania, Area 01 CMS 12502-01 — — $581.29 $552.23 $635.06 Jan 1, 2026 Contractor file
JL · Pennsylvania, Area 01 CMS 12502-01 — # $259.83 $246.84 $283.87 Jan 1, 2026 Contractor file
JL · Pennsylvania, Area 99 CMS 12502-99 — — $519.07 $493.12 $567.09 Jan 1, 2026 Contractor file
JL · Pennsylvania, Area 99 CMS 12502-99 — # $236.00 $224.20 $257.83 Jan 1, 2026 Contractor file
JN · Florida, Area 03 CMS 09102-03 — — $970.02 $921.52 $1,059.75 Jan 1, 2026 Contractor file
JN · Florida, Area 04 CMS 09102-04 — — $1,053.59 $1,000.91 $1,151.05 Jan 1, 2026 Contractor file
JN · Florida, Area 99 CMS 09102-99 — — $905.55 $860.27 $989.31 Jan 1, 2026 Contractor file
JN · Puerto Rico, Area 20 CMS 09202-20 — — $709.05 $673.60 $774.64 Jan 1, 2026 Contractor file
JN · U.S. Virgin Islands, Area 50 CMS 09202-50 — — $709.05 $673.60 $774.64 Jan 1, 2026 Contractor file

The authenticated MAC fees API returns the same source rows. ZIP5s that span localities are flagged and use only the crosswalk's dominant locality until ZIP+4 overrides are available.

Which billing rules and modifiers apply? Copy link

CMS indicators that apply to 43648: GLOB DAYS YYY (contractor decides) · MULT PROC 2 (standard reduction applies) · ASST SURG 2 (payable) · CO SURG 1 (payable with documentation).

Global surgery period

Contractor decides

GLOB DAYS

YYY

Your Medicare Administrative Contractor decides whether a global period applies and sets its length when it prices the code. The result is 0, 10, or 90 days.

Multiple procedures

Standard reduction applies

MULT PROC

2

When billed with other procedures on the same date, the highest-valued one is paid at 100% and the next four at 50% each.

-51 depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one.

Assistant at surgery

Payable

ASST SURG

2

An assistant at surgery may be separately paid for this procedure, typically as a percentage of the fee schedule amount.

Co-surgeons

Payable with documentation

CO SURG

1

Co-surgeons may be paid, but only with supporting documentation establishing the medical necessity of two surgeons.

Why would a Medicare claim for 43648 be denied or paid less?

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

  • Its status indicator is C (carrier-priced)—Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. See status indicators
  • 15 codes form NCCI pairs with 43648 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
  • 63 codes pair with 43648 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 1 unit per patient per date of service exceeds 43648's Medically Unlikely Edit (MUE) limit. See billing together
  • Bilateral surgery: no bilateral adjustment. See billing policy
  • Co-surgeons: payable with documentation. 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.

CMS RVU26DOctober 1 – December 31, 2026revision 2

Can you bill it with another code? Copy link

43648 has 78 NCCI pairs (Q4 2026) and an MUE of 1 unit per patient per date of service.

This code

43648

Modifier indicator 0

15 pairs

No modifier bypasses the edit

Modifier indicator 1

63 pairs

Only with an appropriate, documented modifier

Medically Unlikely Edit (MUE) limit

1 unit

Per patient per date of service

All 78 NCCI pairs for 43648 →

Reconciling a contractor-priced payment for 43648 Copy link

Checking a paid 43648 line?

Check an actual payment Model this code in a contract
What to check (5)

There is no national allowed amount for 43648, so every reconciliation of this line runs against the MAC fee schedule that was in force for the date of service rather than against a national baseline.

  • Compare the paid amount against the MAC fee schedule in force for the date of service; there is no national allowed amount here to reconcile against.
  • Ask the MAC which global period it assigned: the contractor sets the follow-up window for this code, so whether a post-operative visit should have paid depends on the contractor that priced it.
  • 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 that any -80 or -AS line was priced from the same release and locality as the primary line; an assistant at surgery prices at a percentage of the fee-schedule amount.
  • 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 Medicare Claims Processing Manual (Pub. 100-04); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

Source & method Copy link

The PFS file shows this code is priced by the contractor. Its amounts come from the MAC-published schedules and effective dates shown above.

  1. 01 PPRRVU2026_Oct_nonQPP.csv · Q4 2026 (RVU26D) · row 5,278—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q4 2026 release
    Effective
    October 1 – December 31, 2026
    Locator
    PPRRVU2026_Oct_nonQPP.csv in rvu26d-updated-08-26-2026.zip · row 5,278 of 19,453 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 4d0d3f19bd954ffc…
  2. 02 MAC-published fee schedules · 70 on file—the contractor amounts
    Source
    MAC-published fee schedules
    Effective
    Effective dates shown above
  3. 03 NCCI · Q4 2026—the code-pair edits
    Source
    National Correct Coding Initiative (NCCI)
    Effective
    Same quarter as the Q4 2026 rate
  4. 04 Physician & Other Practitioners · CY2024—volume and who bills it limits
    Source
    CMS Physician & Other Practitioners dataset
    Effective
    Calendar-year snapshot, on a different cycle from the Q4 2026 fee schedule
    Doesn’t establish
    Medicare Advantage, Medicaid or commercial volume.
    Note
    The dataset suppresses rows under 11 beneficiaries.

Cite this rate

CPT 43648 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 5,278. Localis. https://localishealth.com/cpt/43648/2026/D

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

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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Usage and related codes Copy link

In CY2024, 43648 ranked #7,290 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Services
59
Allowed
$16,582
Beneficiaries
45

CY2024 Medicare fee-for-service, from the CMS Physician & Other Practitioners dataset (limits).