CPT 44136 Medicare status in Q3 2014: Restricted

Restricted / special payment rules

44136 · PFS Q3 2014 · Historical

No national PFS rate in Q3 2014

Status R: no national PFS amount. The RVUs for this setting are all zero; they do not establish a $0 allowance. Special payment instructions apply.

View applicable payment rules

View CMS source and method

CMS RVU14CJuly 1 – September 30, 2014

PFS status evidence

Physician relative value file (Q3 2014) · rvu14c.zip (PPRRVU14_V0515.csv row 8,605)

Inspect PFS status evidence

Code: 44136
Release: Q3 2014, revision 1
Result: Restricted / special payment rules

Citations

Shows this code’s PFS status (R). Result: Restricted / special payment rules.

Physician relative value file (PPRRVU)CMS RVU14CJuly 1 – September 30, 2014

This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

PPRRVU14_V0515.csv row 8,605 in rvu14c.zip

In the CMS file

Loading rows 8,603–8,607 of PPRRVU14_V0515.csv…

Download rvu14c.zip from CMS File fingerprint c77da0d012ff73dec8680d5f6f50582fc7e72005bc55edb2f131a02f0b1c293c

Report a problem

CPT 44136 has no published national rate. It carries status R (restricted) in the Q3 2014 release. Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. The blank amount means unpriced, not $0.

Why is there no national PFS amount for 44136?

Its status indicator is R (restricted). Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. Status R: no national PFS amount. The RVUs for this setting are all zero; they do not establish a $0 allowance. Special payment instructions apply.

Which billing rules and modifiers apply? Copy link

CMS's surgical and split-billing indicators don't adjust 44136's amount.

Global surgery period XXX (does not apply).

Why would a Medicare claim for 44136 be denied or paid less?

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

Its status indicator is R (restricted)—Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. See status indicators
Bilateral surgery: no bilateral adjustment. See billing policy
Assistant at surgery: restricted without documentation. See billing policy
Co-surgeons: not permitted. See billing policy
Team surgery: not permitted. 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 RVU14CJuly 1 – September 30, 2014

Can you bill it with another code? Copy link

See every current NCCI pair for 44136 →

Payment review for 44136 Copy link

Checking a paid 44136 line?

Check an actual payment Model this code in a contract

What to check (3)

Two published payment rules can change what 44136 allows on a claim: status R coverage instructions and documentation-restricted assistant-at-surgery payment. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.

Treat the published amount as conditional—status R carries special coverage instructions, so a payable fee-schedule amount does not by itself establish that this line should have paid.
Check for documentation on file before appealing an assistant-at-surgery denial: payment on the -80 or -AS line is restricted for this procedure unless medical necessity is established.
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); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

Source & method Copy link

01 PPRRVU14_V0515.csv · Q3 2014 (RVU14C) · row 8,605—status R, RVUs limits

Source

Physician relative value file (PPRRVU), Q3 2014 release

Effective

July 1 – September 30, 2014

Locator

PPRRVU14_V0515.csv in rvu14c.zip · row 8,605 of 15,901 · via CMS

Fields read

Status R (col 4) Work RVU 0 (col 6) Office (non-facility) PE RVU 0 (col 7) Facility PE RVU 0 (col 9) Malpractice RVU 0 (col 11)

SHA-256 c77da0d012ff73de…

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.

Cite this rate

CPT 44136 National PFS baseline: No national PFS rate (Q3 2014; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU14C, PPRRVU14_V0515.csv row 8,605. Localis. https://localishealth.com/cpt/44136/2014/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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