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CPT 44238 Medicare payment status

Contractor-priced

44238 · PFS Q3 2016 · Historical

No national PFS rate in Q3 2016

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

PFS status evidence

Physician relative value file (Q3 2016) · rvu16c.zip (PPRRVU16_V0517.csv row 8,925)
Inspect PFS status evidence
Code
44238
Release
Q3 2016, revision 1
Result
Contractor-priced

Citations

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

    Physician relative value file (PPRRVU)CMS RVU16CJuly 1 – September 30, 2016

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

    PPRRVU16_V0517.csv row 8,925 in rvu16c.zip

    In the CMS file

    Loading rows 8,923–8,927 of PPRRVU16_V0517.csv…

    Download rvu16c.zip from CMS File fingerprint 81464316ee60bdd4aa33b47a636b521a77a73481c795300cbab67f48dbe432d9

Report a problem

CPT 44238 has no published national rate. It carries status C (carrier-priced) in the Q3 2016 release. Your Medicare Administrative Contractor prices this code case by case, usually after reviewing documentation. The blank amount means unpriced, not $0.

Why is there no national PFS amount for 44238?

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

Which billing rules and modifiers apply? Copy link

CMS indicators that apply to 44238: GLOB DAYS YYY (contractor decides) · BILAT SURG 1 (150% bilateral adjustment applies) · MULT PROC 2 (standard reduction applies) · ASST SURG 2 (payable) · CO SURG 1 (payable with documentation) · TEAM 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.

Bilateral surgery

150% bilateral adjustment applies

BILAT SURG

1

Billed bilaterally (modifier 50, or on both sides), Medicare pays 150% of the single-side fee schedule amount.

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.

Team surgery

Payable with documentation

TEAM SURG

1

A surgical team may be paid, but only with supporting documentation establishing medical necessity.

Why would a Medicare claim for 44238 be denied or paid less?

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

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 RVU16CJuly 1 – September 30, 2016

Can you bill it with another code? Copy link

This code

44238

See every current NCCI pair for 44238 →

Reconciling a contractor-priced payment for 44238 Copy link

Checking a paid 44238 line?

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

There is no national allowed amount for 44238, 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.
  • Look for modifier 50 or a second-side line before comparing: billed for both sides, this procedure should price at 150% of the single-side 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).

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 PPRRVU16_V0517.csv · Q3 2016 (RVU16C) · row 8,925—priced by the contractor
    Source
    Physician relative value file (PPRRVU), Q3 2016 release
    Effective
    July 1 – September 30, 2016
    Locator
    PPRRVU16_V0517.csv in rvu16c.zip · row 8,925 of 16,313 · via CMS
    Fields read
    Status C (col 4)
    SHA-256 81464316ee60bdd4…
  2. 02 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 Q3 2016 fee schedule
    Doesn’t establish
    Medicare Advantage, Medicaid or commercial volume.
    Note
    The dataset suppresses rows under 11 beneficiaries.

Cite this rate

CPT 44238 National PFS baseline: No national PFS rate (Q3 2016; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU16C, PPRRVU16_V0517.csv row 8,925. Localis. https://localishealth.com/cpt/44238/2016/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

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, 44238 ranked #2,585 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.

Services
2,057
Allowed
$1.7M
Beneficiaries
1,656

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